NPIMap

Organization Active NPI

Mindscapes Counseling PLLC

Doing business as Tides of Mind Counseling

  • Clinical Social Worker
  • Waterbury, CT
National Provider Identifier
1295130581
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
008064 Issued in CT
Legal business name
MINDSCAPES COUNSELING PLLC
Doing business as
Tides of Mind Counseling
Practice address
230 Frost Rd Unit B
Waterbury, CT 06705-2154
Phone
(203) 819-0789
NPI assigned
Oct 29, 2014
Last updated
Apr 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
REFRESH MENTAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Authorized official

Name
Elliot Richelson, M.D.
Title
President, Secretary, and Treasurer
Phone
(904) 605-4986

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 008064 CT Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

230 Frost Rd Unit B
Waterbury, CT 06705-2154

Mailing address

230 Frost Rd Unit B
Waterbury, CT 06705-2154
Phone (203) 768-4427

Other identifiers 1

IdentifierTypeStateIssuer
008056440MedicaidCT

Other names 1

  • Tides of Mind Counseling Doing business as

National Provider Directory

National Provider Directory
Part of
Mindscapes Counseling PLLC

Locations

191 Albany Tpke
Ste 3
Canton, CT 06019

850 Straits Tpke
Ste 201
Middlebury, CT 06762
Phone (203) 758-2296

169 Main St
Middletown, CT 06457
Phone (860) 985-0337

Practitioners & affiliated clinicians

Practitioners 41

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.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1295130581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 FROST RD UNIT B",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067052154",
            "telephone_number": "203-768-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 FROST RD UNIT B",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067052154",
            "telephone_number": "203-819-0789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDSCAPES COUNSELING PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REFRESH MENTAL HEALTH",
        "enumeration_date": "2014-10-29",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "RICHELSON",
        "authorized_official_first_name": "ELLIOT",
        "authorized_official_title_or_position": "PRESIDENT, SECRETARY, AND TREASURER",
        "authorized_official_telephone_number": "904-605-4986",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "008064",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008056440",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tides of Mind Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.