1609265271 NPI number — MENTAL HEALTH COUNSELING OF OSWEGO COUNTY, PLLC

Table of content: (NPI 1609265271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609265271 NPI number — MENTAL HEALTH COUNSELING OF OSWEGO COUNTY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH COUNSELING OF OSWEGO COUNTY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609265271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
188 S 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13069-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-207-5435
Provider Business Mailing Address Fax Number:
315-410-5544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
188 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13069-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-207-5435
Provider Business Practice Location Address Fax Number:
315-207-5435
Provider Enumeration Date:
01/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GENTILE
Authorized Official First Name:
TIFFANY
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
LMHC, DIRECTOR
Authorized Official Telephone Number:
315-207-5435

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 305S00000X , with the licence number: 837827415 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 837827415 . This is a "SUNY ADJUNCT PROFESSOR REGISTRATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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