Healthcare Provider Details

I. General information

NPI: 1831238542
Provider Name (Legal Business Name): LEWIS COUNTY MH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 SOUTH STATE STREET
LOWVILLE NY
13367
US

IV. Provider business mailing address

7550 SOUTH STATE STREET
LOWVILLE NY
13367
US

V. Phone/Fax

Practice location:
  • Phone: 315-376-5450
  • Fax: 315-376-7221
Mailing address:
  • Phone: 315-376-5450
  • Fax: 315-376-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6871100A
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number6871100A
License Number StateNY

VIII. Authorized Official

Name: TOBY K DAVIS
Title or Position: DIRECTOR
Credential: PHD
Phone: 315-376-5450