Provider Demographics
NPI:1528300902
Name:SEALY MENTAL HEALTH COUNSELING SERVICE INC.
Entity type:Organization
Organization Name:SEALY MENTAL HEALTH COUNSELING SERVICE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEALY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,LMHC
Authorized Official - Phone:508-752-5444
Mailing Address - Street 1:370 MAIN ST STE 910
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1723
Mailing Address - Country:US
Mailing Address - Phone:508-752-5444
Mailing Address - Fax:
Practice Address - Street 1:370 MAIN ST STE 910
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1723
Practice Address - Country:US
Practice Address - Phone:508-752-5444
Practice Address - Fax:661-360-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-23
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty