Healthcare Provider Details

I. General information

NPI: 1427711407
Provider Name (Legal Business Name): IAN MATTHEW WINSOME LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: IAN MATTHEW WALZ LMHC

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 N CATHERINE ST
PLATTSBURGH NY
12901-3380
US

IV. Provider business mailing address

5114 N CATHERINE ST
PLATTSBURGH NY
12901-3380
US

V. Phone/Fax

Practice location:
  • Phone: 518-227-0294
  • Fax:
Mailing address:
  • Phone: 518-954-9381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: