Provider Demographics
NPI:1083176770
Name:PREMIER COUNSELING & PSYCHOTHERAPY
Entity Type:Organization
Organization Name:PREMIER COUNSELING & PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-825-6810
Mailing Address - Street 1:347 5TH AVE RM 703A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5036
Mailing Address - Country:US
Mailing Address - Phone:929-376-9303
Mailing Address - Fax:
Practice Address - Street 1:347 5TH AVE RM 703A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5036
Practice Address - Country:US
Practice Address - Phone:929-376-9303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty