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General NPI Number Information
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NPI Number | 1790440709
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Entity Type | Organization
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Legal Business Name | LIFTED HEART MENTAL HEALTH COUNSELING, PLLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 820 STATE ROUTE 9 UNIT 4720
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City | QUEENSBURY
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State | NY
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Zip | 12804-5425
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Country | US
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Telephone | 518-480-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 820 STATE ROUTE 9 UNIT 4720
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City | QUEENSBURY
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State | NY
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Zip | 12804-5425
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Country | US
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Telephone | 518-480-7337
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNDER
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Name | TARA BOOTH
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Credential | LMHC
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Telephone | 518-480-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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