| Scott L Gourson Llc | |
|
111 Main St Collinsville CT 06019-3182 | |
| (860) 693-4201 | |
| (860) 693-4991 |
| Full Name | Scott L Gourson Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 111 Main St, Collinsville, Connecticut |
| Authorized Official Name and Position | Scott L Gourson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8606934201 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Scott L Gourson Llc 111 Main St Collinsville CT 06019-3182 Ph: (860) 693-4201 | Scott L Gourson Llc 111 Main St Collinsville CT 06019-3182 Ph: (860) 693-4201 |
| NPI Number | 1801147400 |
|---|---|
| Provider Enumeration Date | 09/24/2012 |
| Last Update Date | 09/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801147400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 001858 (Connecticut) | Primary |
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