MEDICARE: THE FAMILY COUNSELING CENTER OF FULTON COUNTY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084P0800X	Psychiatry Physician
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164473831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY COUNSELING CENTER OF FULTON COUNTY INC

Provider Business Mailing Address
First Line	:	11-21 BROADWAY
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-3968
Country	:	US
Telephone Number	:	518-725-4310
Fax Number	:	518-725-2556

Provider Business Practice Location Address
First Line	:	11-21 BROADWAY
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-3968
Country	:	US
Telephone Number	:	518-725-4310
Fax Number	:	518-725-2556

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL COUNTRYMAN
Credential	:
Telephone Number	:	518-725-4310

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	04/27/2018

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