Provider Demographics
NPI:1376953117
Name:NEO MENTAL HEALTH COUNSELING, PC
Entity Type:Organization
Organization Name:NEO MENTAL HEALTH COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:OUTEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:347-423-4548
Mailing Address - Street 1:2046 SEAGIRT BLVD
Mailing Address - Street 2:APT 5-F
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5950
Mailing Address - Country:US
Mailing Address - Phone:718-868-0515
Mailing Address - Fax:
Practice Address - Street 1:4130 75TH ST FL 1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1852
Practice Address - Country:US
Practice Address - Phone:347-423-4548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000758-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty