Healthcare Provider Details

I. General information

NPI: 1134637812
Provider Name (Legal Business Name): SENIOR COUNSELING OF WESTERN MASS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 UNION ST STE 23
WEST SPRINGFIELD MA
01089-3485
US

IV. Provider business mailing address

245 RUSSELL ST STE 21C
HADLEY MA
01035-9001
US

V. Phone/Fax

Practice location:
  • Phone: 413-276-6111
  • Fax:
Mailing address:
  • Phone: 413-276-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: INDRA HARRIS
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 413-276-6111