Trellis Counseling and Wellness LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

TRELLIS COUNSELING AND WELLNESS LLC

Practice address

38 Patula CT
Southington, CT 06489-1816

Phone

(203) 508-0644

NPI assigned

Oct 14, 2020

Last updated

Oct 14, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Theresa Marie Chawner, MSW, LCSWNPI 1548446925

Title

Chief Executive Officer

Phone

(203) 508-0644

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theresa Marie Chawner, LCSW

  • Clinical Social Worker
  • Southington, CT
  • NPI 1548446925
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1265030910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 PATULA CT",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064891816",
            "telephone_number": "203-508-0644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 PATULA CT",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064891816",
            "telephone_number": "203-508-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRELLIS COUNSELING AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "CHAWNER",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "203-508-0644",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008084862",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jotform.com",
            "affiliation": "N",
            "endpointDescription": "HIPAA Compliant Client Data Submission Portal",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Provider logs into jotform/HIPAA compliant website to retrieve information",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Client freeform demographic and healthcare information",
            "address_1": "38 Patula Ct",
            "city": "Southington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "064891816",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "therapynotes.com",
            "affiliation": "N",
            "endpointDescription": "HIPAA compliant electronic health record product website",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Provider logs into TherapyNotes/HIPAA compliant website to enter/retrieve information",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Client freeform demographic and healthcare information",
            "address_1": "38 Patula Ct",
            "city": "Southington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "064891816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Benjamin Timakov, PHARMD
• Todd a Perkins Aprn LLC
• Kimberly L Torres-Bacon, LMFT
• Tracie Preli-Derwin, LCSW, PLLC
• Tien Tran, RPH
• Nicholas Paul Peter Truncali, DPT
• Megan Elizabeth Turner, LCSW
• Turning Point Wellness, LLC
• UC of Southington, LLC
• Nymisha Upadhyayula

• Clinical Social Worker in Southington, CT
• Providers in Southington, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.