Provider Demographics
NPI:1538596374
Name:MAIN STREET COUNSELING, LLC
Entity type:Organization
Organization Name:MAIN STREET COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEALL-GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC
Authorized Official - Phone:203-449-7908
Mailing Address - Street 1:115 MAIN ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1662
Mailing Address - Country:US
Mailing Address - Phone:203-449-7908
Mailing Address - Fax:203-905-6752
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:UNIT 4
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1662
Practice Address - Country:US
Practice Address - Phone:203-449-7908
Practice Address - Fax:203-905-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty