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General NPI Number Information
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NPI Number | 1043008071
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Entity Type | Organization
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Legal Business Name | FRESH START COUNSELING LLC
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 114 LIBERTY ST # 4
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City | BATAVIA
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State | NY
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Zip | 14020-3533
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Country | US
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Telephone | 585-318-6257
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Fax |
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Provider Business Mailing Address
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Address Line | 1791 STATE ROUTE
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City | WYOMING
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State | NY
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Zip | 14591
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Country | US
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Telephone | 585-409-6357
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Fax | 585-409-6357
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JUDITH MARIE PRATT
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Credential | LMSW
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Telephone | 585-318-7264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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