Provider Demographics
NPI:1598578361
Name:WINDING RIVERS MENTAL HEALTH
Entity type:Organization
Organization Name:WINDING RIVERS MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:BLAIN
Authorized Official - Last Name:LARCHEVEQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-216-7901
Mailing Address - Street 1:80 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3120
Mailing Address - Country:US
Mailing Address - Phone:860-216-7901
Mailing Address - Fax:
Practice Address - Street 1:121 MAIN ST
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3125
Practice Address - Country:US
Practice Address - Phone:860-216-7901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty