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General NPI Number Information
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NPI Number | 1134189616
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Entity Type | Organization
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Legal Business Name | BIG TREE COUNSELING PSYCOLOGICAL PLLC
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 4828 LAKEVILLE ROAD
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City | GENESCO
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State | NY
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Zip | 14454
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Country | US
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Telephone | 585-243-2394
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Fax | 585-243-9341
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Provider Business Mailing Address
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Address Line | PO BOX 356 4828 LAKEVILLE ROAD
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City | GENESEO
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State | NY
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Zip | 14454-0356
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Country | US
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Telephone | 585-243-2394
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Fax | 585-243-9341
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | ANNA M HOIER
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Credential | PSYD
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Telephone | 585-243-2394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | R014648
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License Number State | NY
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