Healthcare Provider Details

I. General information

NPI: 1124942982
Provider Name (Legal Business Name): THERAPY MOTIVATED MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 NASSAU BLVD
WILLISTON PARK NY
11596-2326
US

IV. Provider business mailing address

451 NASSAU BLVD
WILLISTON PARK NY
11596-2326
US

V. Phone/Fax

Practice location:
  • Phone: 347-456-0303
  • Fax:
Mailing address:
  • Phone: 347-456-0303
  • Fax:

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: EDWARD FERNANDEZ
Title or Position: LICENSE MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 347-456-0303