Provider Demographics
NPI:1154201226
Name:CONSTELLATIONS PSYCHOTHERAPY & CONSULTING, LLC
Entity type:Organization
Organization Name:CONSTELLATIONS PSYCHOTHERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAILAE-BRYZILE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LPC
Authorized Official - Phone:850-390-0611
Mailing Address - Street 1:2389 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4617
Mailing Address - Country:US
Mailing Address - Phone:203-343-0081
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST # 1320
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2701
Practice Address - Country:US
Practice Address - Phone:203-343-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)