NPIMap

Organization Active NPI

Wolf Spirit Wellness and Counseling Center, LLC

  • Community/Behavioral Health Agency
  • Woodbury, CT
National Provider Identifier
1710480520
Registry record updated Mar 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
3416 Issued in CT
Legal business name
WOLF SPIRIT WELLNESS AND COUNSELING CENTER, LLC
Practice address
125 Main St N Ste 2B
Woodbury, CT 06798-2953
Phone
(203) 263-3175
Fax
(844) 364-2702
NPI assigned
Mar 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2018

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

Authorized official

Name
Ms. Julie A Levesque, LPCNPI 1083117899
Title
Therapist
Phone
(203) 263-3175

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 3416 CT Primary

Addresses

Primary practice location

125 Main St N Ste 2B
Woodbury, CT 06798-2953

Mailing address

236 Washington Rd
Woodbury, CT 06798-2807
Phone (203) 263-3175

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230315001744 CT Part B Supplier - Clinic/Group Practice 0244604114 Receives reassigned benefits from 4 practitioners
Practice locations: Woodbury, CT

National Provider Directory

National Provider Directory

Locations

125 Main St N
Ste 2B
Woodbury, CT 06798
Phone (203) 263-3175

670 Main St S
#B2
Woodbury, CT 06798
Phone (203) 263-3175

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1521331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521331200000",
    "number": "1710480520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 WASHINGTON RD",
            "city": "WOODBURY",
            "state": "CT",
            "postal_code": "067982807",
            "telephone_number": "203-263-3175",
            "fax_number": "844-364-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MAIN ST N STE 2B",
            "city": "WOODBURY",
            "state": "CT",
            "postal_code": "067982953",
            "telephone_number": "203-263-3175",
            "fax_number": "844-364-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLF SPIRIT WELLNESS AND COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-18",
        "last_updated": "2018-03-18",
        "status": "A",
        "authorized_official_last_name": "LEVESQUE",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "203-263-3175",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CT",
            "license": "3416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2018; 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.