MEDICARE: MENTAL HEALTH COUNSELING THERAPEUTIC SERVICES PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801626098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH COUNSELING THERAPEUTIC SERVICES PLLC

Provider Business Mailing Address
First Line	:	169 COMMACK RD STE 382
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-3442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 COMMACK RD STE 382
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-3442
Country	:	US
Telephone Number	:	917-624-0124
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY N VILLACIS
Credential	:
Telephone Number	:	917-624-0124

Provider Enumeration Date	:	08/03/2024
Last Update Date	:	08/03/2024

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