Healthcare Provider Details

I. General information

NPI: 1588686596
Provider Name (Legal Business Name): TOMPKINS COUNTY MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GREEN ST
ITHACA NY
14850-5421
US

IV. Provider business mailing address

201 E GREEN ST
ITHACA NY
14850-5421
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-6305
  • Fax: 607-274-6316
Mailing address:
  • Phone: 607-274-6305
  • Fax: 607-274-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6892300A
License Number StateNY

VIII. Authorized Official

Name: JEREMY PORTER
Title or Position: FISCAL ADMINISTRATOR
Credential:
Phone: 607-274-6200