Provider Demographics
NPI:1568643468
Name:STONE MOUNTAIN COUNSELING, LMHC, P.C.
Entity Type:Organization
Organization Name:STONE MOUNTAIN COUNSELING, LMHC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-658-8083
Mailing Address - Street 1:310 RIVER ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3080
Mailing Address - Country:US
Mailing Address - Phone:845-658-8083
Mailing Address - Fax:845-658-3874
Practice Address - Street 1:310 RIVER ROAD EXT
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-3080
Practice Address - Country:US
Practice Address - Phone:845-658-8083
Practice Address - Fax:845-658-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002944-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center