Provider Demographics
NPI:1578061750
Name:CHRISTINA L. GMYR, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Entity Type:Organization
Organization Name:CHRISTINA L. GMYR, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GMYR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC
Authorized Official - Phone:315-228-0866
Mailing Address - Street 1:12 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1186
Mailing Address - Country:US
Mailing Address - Phone:315-228-0866
Mailing Address - Fax:
Practice Address - Street 1:12 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1186
Practice Address - Country:US
Practice Address - Phone:315-503-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004828-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)