Provider Demographics
NPI:1831665538
Name:1 INTEGRAL MENTAL HEALTH COUNSELING PRACTICE PLLC
Entity Type:Organization
Organization Name:1 INTEGRAL MENTAL HEALTH COUNSELING PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TOLLI-ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:929-522-0631
Mailing Address - Street 1:9609 40TH RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2138
Mailing Address - Country:US
Mailing Address - Phone:929-522-0631
Mailing Address - Fax:
Practice Address - Street 1:9609 40TH RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2138
Practice Address - Country:US
Practice Address - Phone:929-522-0631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)