| 1 Integral Mental Health Counseling Practice Pllc | |
|
9609 40th Rd Corona NY 11368-2138 | |
| (929) 522-0631 | |
| Not Available |
| Full Name | 1 Integral Mental Health Counseling Practice Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9609 40th Rd, Corona, New York |
| Authorized Official Name and Position | Stephanie D Tolli-abraham (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9295220631 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 1 Integral Mental Health Counseling Practice Pllc 9609 40th Rd Corona NY 11368-2138 Ph: (929) 522-0631 | 1 Integral Mental Health Counseling Practice Pllc 9609 40th Rd Corona NY 11368-2138 Ph: (929) 522-0631 |
| NPI Number | 1831665538 |
|---|---|
| Provider Enumeration Date | 10/19/2018 |
| Last Update Date | 10/19/2018 |
| Medicare PECOS PAC ID | 5698019263 |
|---|---|
| Medicare Enrollment ID | O20181208000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831665538 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ted Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184002404 PECOS PAC ID: 2466796974 Enrollment ID: I20181210001770 |
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