Healthcare Provider Details

I. General information

NPI: 1003641606
Provider Name (Legal Business Name): URBAN MENTAL HEALTH COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 FAIRMOUNT AVE
JAMESTOWN NY
14701-2608
US

IV. Provider business mailing address

779 FAIRMOUNT AVE
JAMESTOWN NY
14701-2608
US

V. Phone/Fax

Practice location:
  • Phone: 716-205-0325
  • Fax:
Mailing address:
  • Phone: 716-205-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: OSAZE BATHOLOMEW IBHAWA
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 716-322-9088