Organization
SCOTT L GOURSON LLC
Active
Organization
SCOTT L GOURSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT L GOURSON PHD, LPC, LDAC, CCDP (EXECUTIVE DIRECTOR)
(860) 693-4201
Entity
Organization
Contact information
Practice address
111 MAIN ST, COLLINSVILLE, CT 06019-3182
(860) 693-4201
(860) 693-4991
Mailing address
111 MAIN ST, COLLINSVILLE, CT 06019-3182
(860) 693-4201
(860) 693-4991
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
001858
CT
Other
Enumeration date
09/24/2012
Last updated
09/24/2012
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