Provider Demographics
NPI:1134189616
Name:BIG TREE COUNSELING PSYCOLOGICAL PLLC
Entity type:Organization
Organization Name:BIG TREE COUNSELING PSYCOLOGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOIER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:585-243-2394
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:4828 LAKEVILLE ROAD
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-0356
Mailing Address - Country:US
Mailing Address - Phone:585-243-2394
Mailing Address - Fax:585-243-9341
Practice Address - Street 1:4828 LAKEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:GENESCO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-243-2394
Practice Address - Fax:585-243-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR014648103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7352024OtherEMPIRE
NY115158FCOtherPREFERRED CARE
NY02146514Medicaid
7347503OtherAETNA
30014648OtherBCBS
NY115158FCOtherPREFERRED CARE
NYCC5003Medicare ID - Type Unspecified