Spirit Clinic LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SPIRIT CLINIC LLC

Doing business as

Spirit Clinic

Practice address

64 Wall St Ste 306
Norwalk, CT 06850-3403

Phone

(347) 622-9524

NPI assigned

Jan 5, 2020

Organization subpart

No

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

Authorized official

Name

Cristal Sampson, PMHNP-BC

Title

Owner, Clinician

Phone

(347) 622-9524

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Spirit Clinic Doing business as

Locations

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

{
    "created_epoch": "1578182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578182400000",
    "number": "1770122947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 WALL ST STE 306",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 WALL ST STE 306",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503403",
            "telephone_number": "347-622-9524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPIRIT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-05",
        "last_updated": "2020-01-05",
        "certification_date": "2020-01-05",
        "status": "A",
        "authorized_official_last_name": "SAMPSON",
        "authorized_official_first_name": "CRISTAL",
        "authorized_official_title_or_position": "OWNER, CLINICIAN",
        "authorized_official_telephone_number": "347-622-9524",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1942700430",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spirit Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Norwalk, CT
• Providers in Norwalk, CT by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2020; 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.