=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124532189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTUITIVE MENTAL HEALTH COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2017
-----------------------------------------------------
Last Update Date | 11/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 MAIN ST
-----------------------------------------------------
City | NEW PALTZ
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12561-1551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-522-9368
-----------------------------------------------------
Fax | 845-853-1551
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 648
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12528-0648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-522-9368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | KRISTEN A. NASTA
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 845-522-9368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 004268
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------