Provider Demographics
NPI:1245966480
Name:BRENDA L. GAUSBY MENTAL HEALTH COUNSELOR PLLC
Entity type:Organization
Organization Name:BRENDA L. GAUSBY MENTAL HEALTH COUNSELOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LORAINE
Authorized Official - Last Name:GAUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:518-832-0204
Mailing Address - Street 1:2130 STATE RT 43
Mailing Address - Street 2:AVERILL PARK
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018
Mailing Address - Country:US
Mailing Address - Phone:518-832-0204
Mailing Address - Fax:
Practice Address - Street 1:2130 STATE RT 43
Practice Address - Street 2:AVERILL PARK
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018
Practice Address - Country:US
Practice Address - Phone:518-832-0204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty