# SOUTHWEST TRAUMA INFORMED INTEGRATED CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043942899
- **Authorized official:** FELISHA MACK DNP, APRN (PMHNP-BC, FNP-BC)
- **Authorized official phone:** (475) 298-3887

## Contact information

- **Practice address:** 125 SHANLEY ST, STRATFORD, CT 06615-6944
- **Practice address phone:** (475) 298-3887
- **Mailing address:** 125 SHANLEY ST, STRATFORD, CT 06615-6944

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/29/2022
- **Last updated:** 06/29/2022