=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821535782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATIONAL ALLIANCE FOR THE MENTALLY ILL OF CHAMPLAIN VALLEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2017
-----------------------------------------------------
Last Update Date | 01/30/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 NEW YORK RD
-----------------------------------------------------
City | PLATTSBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12903-3992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-561-2685
-----------------------------------------------------
Fax | 518-536-9047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 NEW YORK RD
-----------------------------------------------------
City | PLATTSBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12903-3992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-561-2685
-----------------------------------------------------
Fax | 518-536-9047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | AMANDA L BULRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-561-2685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------