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General NPI Number Information
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NPI Number | 1366434011
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Entity Type | Organization
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Legal Business Name | FINGER LAKES AREA COUNSELING AND RECOVERY AGENCY, INC.
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 28 E MAIN ST
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432
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Country | US
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Telephone | 315-462-9466
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Fax | 315-462-6400
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Provider Business Mailing Address
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Address Line | 28 E MAIN ST
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-1231
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Country | US
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Telephone | 315-462-9466
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Fax | 315-462-6400
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MARTIN TELLER
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Credential | MA
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Telephone | 315-462-9466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 8481001A
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190312132
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | NY
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