Provider Demographics
NPI:1356651285
Name:MENTAL HEALTH COUNSELING SERVICES OF NORTHERN NEW YORK, PLLC
Entity Type:Organization
Organization Name:MENTAL HEALTH COUNSELING SERVICES OF NORTHERN NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:315-268-0264
Mailing Address - Street 1:6956 STATE HIGHWAY 56 STE 1
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3570
Mailing Address - Country:US
Mailing Address - Phone:315-268-0264
Mailing Address - Fax:316-268-0200
Practice Address - Street 1:6956 STATE HIGHWAY 56 STE 1
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3570
Practice Address - Country:US
Practice Address - Phone:315-268-0264
Practice Address - Fax:315-268-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000505-1101YM0800X
NY0034261101YM0800X
NYP75607101YM0800X
NY003753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty