Healthcare Provider Details

I. General information

NPI: 1336163963
Provider Name (Legal Business Name): FAMILY COUNSELING SERVICES OF CORTLAND COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MAIN ST. SUITE A
CORTLAND NY
13045
US

IV. Provider business mailing address

165 MAIN ST. SUITE A
CORTLAND NY
13045
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-0234
  • Fax: 607-753-0286
Mailing address:
  • Phone: 607-753-0234
  • Fax: 607-753-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LISA HOESCHELE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 607-753-0234