Provider Demographics
NPI:1073951075
Name:COLUMBIA COUNTY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:COLUMBIA COUNTY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH CARE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:518-828-9446
Mailing Address - Street 1:325 COLUMBIA ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1902
Mailing Address - Country:US
Mailing Address - Phone:518-828-9446
Mailing Address - Fax:518-828-9450
Practice Address - Street 1:325 COLUMBIA ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1902
Practice Address - Country:US
Practice Address - Phone:518-828-9446
Practice Address - Fax:518-828-9450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA COUNTY DEPARTMENT OF HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1689618977Medicaid