Provider Demographics
NPI:1609265271
Name:MENTAL HEALTH COUNSELING OF OSWEGO COUNTY, PLLC
Entity type:Organization
Organization Name:MENTAL HEALTH COUNSELING OF OSWEGO COUNTY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LMHC, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-207-5435
Mailing Address - Street 1:188 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1801
Mailing Address - Country:US
Mailing Address - Phone:315-207-5435
Mailing Address - Fax:315-410-5544
Practice Address - Street 1:188 S 3RD ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1801
Practice Address - Country:US
Practice Address - Phone:315-207-5435
Practice Address - Fax:315-207-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY837827415305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY837827415OtherSUNY ADJUNCT PROFESSOR REGISTRATION