Into the Woods LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

INTO THE WOODS LLC

Practice address

760 Bantam Rd
Bantam, CT 06750-1603

Phone

(860) 412-4547

NPI assigned

Oct 11, 2018

Last updated

Oct 11, 2018By 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

Krystle Sullivan, LPCNPI 1295269504

Title

Clinician

Phone

(860) 412-4547

Specialties & licenses 1

Addresses

Locations

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.

• Krystle Lynn Sullivan, LPC

  • Professional Counselor
  • Windham, CT
  • NPI 1295269504
  NPD Authorized official

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

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539216000000",
    "number": "1295200608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 BANTAM RD",
            "city": "BANTAM",
            "state": "CT",
            "postal_code": "067501603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 BANTAM RD",
            "city": "BANTAM",
            "state": "CT",
            "postal_code": "067501603",
            "telephone_number": "860-412-4547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTO THE WOODS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-11",
        "last_updated": "2018-10-11",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KRYSTLE",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "860-412-4547",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Bantam, CT
• Providers in Bantam, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; 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.