Provider Demographics
NPI:1023871324
Name:INCLUSIVE MENTAL HEALTH COUNSELING SERVICES ,PLLC
Entity type:Organization
Organization Name:INCLUSIVE MENTAL HEALTH COUNSELING SERVICES ,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:OCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:131-549-2489
Mailing Address - Street 1:107 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1407
Mailing Address - Country:US
Mailing Address - Phone:315-492-4899
Mailing Address - Fax:315-883-8305
Practice Address - Street 1:107 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1407
Practice Address - Country:US
Practice Address - Phone:315-492-4899
Practice Address - Fax:315-883-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002419-01OtherINSURANCE COMPANIES
NY02046257Medicaid