Waves of Growth Therapy, LLC
Organization Active NPI Community/Behavioral Health Agency · Gales Ferry, CT
NPI 1700429180 · NPPES record last updated Oct 18, 2019
Key facts
- NPI
- 1700429180
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- WAVES OF GROWTH THERAPY, LLC
- Practice address
- 2 Chapman LN Ste F
Gales Ferry, CT 06335-1200 - Phone
- (860) 705-9984
- NPI assigned
- Oct 18, 2019
- Organization subpart
- No
Authorized official
- Name
- Mikayla Sleeter, LPC
- Title
- Licensed Professional Counselor
- Phone
- (860) 705-9984
Practitioners 1
-
Mikayla E Bozym, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251114000265 | CT | Part B Supplier - Clinic/Group Practice | 3375034622 |
Receives reassigned benefits from 1 practitioner Practice locations: Gales Ferry, CT |
National Provider Directory
Locations
2 Chapman Ln
Ste J
Gales Ferry, CT 06335
Phone (860) 705-9984
2 Chapman Ln
Ste F
Gales Ferry, CT 06335
Phone (860) 705-9984
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
2 Chapman LN Ste F
Gales Ferry, CT 06335-1200
Mailing address
17 Ramblewood Dr
Gales Ferry, CT 06335-1641
Phone (860) 705-9984
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831558550 | Other | NPI NUMBER |
Other providers in Gales Ferry, CT
- Lauryl Spera
- Marie F Stone
- Thriving Potential, PLLC
- Emily Traglia
- Michelle N Watson
- Lynn Marie Wisniewski
- Michelle Lynn Woods-Sweatland
- Jonathan Zane
All providers in Gales Ferry, CT · Community/Behavioral Health Agency in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.