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General NPI Number Information
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NPI Number | 1578221966
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Entity Type | Organization
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Legal Business Name | PLEASANTVILLE WELLNESS LLC
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 57 WHEELER AVE STE 208
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-3038
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Country | US
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Telephone | 917-512-8557
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Fax |
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Provider Business Mailing Address
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Address Line | 57 WHEELER AVE STE 208
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-3038
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Country | US
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Telephone | 917-512-8557
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY KECK
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Credential | LMHC
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Telephone | 914-943-9672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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