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General NPI Number Information
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NPI Number | 1992458798
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Entity Type | Organization
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Legal Business Name | GAINING GROUND MENTAL HEALTH COUNSELING PLLC
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 225 BROADWAY STE 3400
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City | NEW YORK
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State | NY
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Zip | 10007-3054
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Country | US
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Telephone | 585-507-4916
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Fax | 332-345-2040
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Provider Business Mailing Address
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Address Line | 2604 ELMWOOD AVE STE 149
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City | ROCHESTER
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State | NY
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Zip | 14618-2213
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Country | US
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Telephone | 585-507-4916
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Fax | 332-345-2040
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Authorized Official
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Title or Position | OWNER
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Name | MR. KYLE FULLMER
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Credential | LMHC
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Telephone | 937-479-0717
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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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