Healthcare Provider Details

I. General information

NPI: 1205695665
Provider Name (Legal Business Name): KMP THERAPY LICENSED MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W 30TH ST RM 903
NEW YORK NY
10001-0981
US

IV. Provider business mailing address

26 JOMAR RD
SHOREHAM NY
11786-1936
US

V. Phone/Fax

Practice location:
  • Phone: 631-632-5136
  • Fax:
Mailing address:
  • Phone: 631-632-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANABELL MORALES
Title or Position: BOOK KEEPER
Credential:
Phone: 212-877-5500