Provider Demographics
NPI:1922643626
Name:ENVISION BEYOND COUNSELING LLC
Entity Type:Organization
Organization Name:ENVISION BEYOND COUNSELING LLC
Other - Org Name:ENVISION BEYOND COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-641-9924
Mailing Address - Street 1:49 QUEBEC DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3872
Mailing Address - Country:US
Mailing Address - Phone:845-641-9924
Mailing Address - Fax:
Practice Address - Street 1:7600 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1728
Practice Address - Country:US
Practice Address - Phone:845-641-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty