Healthcare Provider Details

I. General information

NPI: 1952108409
Provider Name (Legal Business Name): CAMPOS MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 USHERS RD STE 210
BALLSTON LAKE NY
12019-1555
US

IV. Provider business mailing address

315 USHERS RD STE 210
BALLSTON LAKE NY
12019-1555
US

V. Phone/Fax

Practice location:
  • Phone: 347-251-2834
  • Fax: 929-322-9200
Mailing address:
  • Phone: 347-251-2834
  • Fax: 929-322-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULISSA MARTINEZ
Title or Position: OWNER
Credential: LMHC-D, NCC, CASAC
Phone: 347-251-2834