Healthcare Provider Details

I. General information

NPI: 1912813007
Provider Name (Legal Business Name): MELISSA M KALLFELZ CHOOSING CHANGE COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 FENNELL ST STE 5
SKANEATELES NY
13152-1241
US

IV. Provider business mailing address

29 FENNELL ST STE 5
SKANEATELES NY
13152-1241
US

V. Phone/Fax

Practice location:
  • Phone: 315-308-5345
  • Fax: 315-320-9253
Mailing address:
  • Phone: 315-308-5345
  • Fax: 315-320-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MELISSA M M KALLFELZ
Title or Position: OWNER
Credential: LMHC
Phone: 315-308-5345