Provider Demographics
NPI:1447008628
Name:HEALTHY SELF MENTAL HEALTH COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:HEALTHY SELF MENTAL HEALTH COUNSELING SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PALAK
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:516-342-0481
Mailing Address - Street 1:96 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-2023
Mailing Address - Country:US
Mailing Address - Phone:516-342-0481
Mailing Address - Fax:
Practice Address - Street 1:240 MADISON AVE # 10L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2820
Practice Address - Country:US
Practice Address - Phone:516-342-0481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-11
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty