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General NPI Number Information
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NPI Number | 1497564876
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Entity Type | Organization
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Legal Business Name | BRANCH OUT MENTAL HEALTH COUNSELING PLLC
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 186 WHITE POND RD
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City | STORMVILLE
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State | NY
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Zip | 12582-5719
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Country | US
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Telephone | 845-768-2088
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Fax |
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Provider Business Mailing Address
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Address Line | 455 TARRYTOWN RD STE 1445
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City | WHITE PLAINS
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State | NY
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Zip | 10607-1313
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. REBECCA WAGNER
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Credential | LMHC
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Telephone | 914-255-2075
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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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