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General NPI Number Information
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NPI Number | 1568643468
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Entity Type | Organization
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Legal Business Name | STONE MOUNTAIN COUNSELING, LMHC, P.C.
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 310 RIVER ROAD EXT
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City | NEW PALTZ
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State | NY
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Zip | 12561-3080
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Country | US
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Telephone | 845-658-8083
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Fax | 845-658-3874
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Provider Business Mailing Address
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Address Line | 310 RIVER ROAD EXT
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City | NEW PALTZ
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State | NY
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Zip | 12561-3080
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Country | US
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Telephone | 845-658-8083
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Fax | 845-658-3874
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. H. STEPHEN LARSEN
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Credential | PH.D.
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Telephone | 845-658-8083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 002944-1
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License Number State | NY
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