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General NPI Number Information
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NPI Number | 1922643626
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Entity Type | Organization
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Legal Business Name | ENVISION BEYOND COUNSELING LLC
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 7600 JERICHO TPKE
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City | WOODBURY
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State | NY
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Zip | 11797-1728
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Country | US
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Telephone | 845-641-9924
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Fax |
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Provider Business Mailing Address
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Address Line | 49 QUEBEC DR
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-3872
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Country | US
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Telephone | 845-641-9924
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | DAVID LESSER
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Credential |
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Telephone | 845-641-9924
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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 |
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