Provider Demographics
NPI:1801626098
Name:MENTAL HEALTH COUNSELING THERAPEUTIC SERVICES PLLC
Entity type:Organization
Organization Name:MENTAL HEALTH COUNSELING THERAPEUTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:VILLACIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-624-0124
Mailing Address - Street 1:169 COMMACK RD STE 382
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:169 COMMACK RD STE 382
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3442
Practice Address - Country:US
Practice Address - Phone:917-624-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty