Provider Demographics
NPI:1073133187
Name:UNIFIED MENTAL HEALTH COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:UNIFIED MENTAL HEALTH COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:585-329-7853
Mailing Address - Street 1:6881 4TH SECTION RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2412
Mailing Address - Country:US
Mailing Address - Phone:585-329-7853
Mailing Address - Fax:585-486-7011
Practice Address - Street 1:12 AMITY ST
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1350
Practice Address - Country:US
Practice Address - Phone:585-329-7853
Practice Address - Fax:585-486-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty