Organization
TRACY CLOUGH, LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY CLOUGH LCSW (OWNER)
(973) 809-4722
Entity
Organization
Contact information
Practice address
515 BRIDGEPORT AVE, JOURNEY TO WELLNESS SUITE, SHELTON, CT 06484
(203) 814-8113
Mailing address
298 PARK LN, TRUMBULL, CT 06611-2254
(973) 809-4722
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
010006
CT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
010006
CT
261QM0850X
Adult Mental Health Clinic/Center
Primary
010006
CT
261QM0855X
Adolescent and Children Mental Health Clinic/Center
010006
CT
Other
Enumeration date
03/08/2018
Last updated
03/17/2018
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