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NPI 1750295523

NPI 1750295523 : KG MENTAL HEALTH COUNSELING PC : GARDEN CITY, NY

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General NPI Number Information
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    NPI Number           |    1750295523
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    Entity Type          |    Organization 
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    Legal Business Name  |    KG MENTAL HEALTH COUNSELING PC 
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Dates
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    Enumeration Date     |    09/29/2026
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    Last Update Date     |    09/29/2026
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Provider Practice Location Address
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    Address Line         |    111 7TH ST UNIT 111 
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    City                 |    GARDEN CITY
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    State                |    NY
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    Zip                  |    11530-5709
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    Country              |    US
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    Telephone            |    516-765-7614
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    111 7TH ST UNIT 111 
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    City                 |    GARDEN CITY
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    State                |    NY
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    Zip                  |    11530-5709
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    Country              |    US
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    Telephone            |    516-765-7614
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     KIERAN  GILLESPIE 
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    Credential           |    LMHC
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    Telephone            |    516-765-7614
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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 |    NULL
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