NPIMap

Organization Active NPI

Clinton County

  • Mental Health Counselor
  • Plattsburgh, NY
National Provider Identifier
1164465902
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
685511 Issued in NY
Legal business name
CLINTON COUNTY
Practice address
130 Arizona Ave Ste 1500
Plattsburgh, NY 12903-4908
Phone
(518) 565-4060
Fax
(518) 566-0168
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richelle Gregory
Title
Director of Community Services
Phone
(518) 565-4060

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 05727 NY
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 685511 NY Primary

Addresses

Primary practice location

130 Arizona Ave Ste 1500
Plattsburgh, NY 12903-4908

Mailing address

130 Arizona Ave Ste 1500
Plattsburgh, NY 12903-4908
Phone (518) 565-4060

Other practice location 1

18 Ampersand Dr
Plattsburgh, NY 12901-6500
Phone (518) 566-0100

Other identifiers 1

IdentifierTypeStateIssuer
00672046MedicaidNY

Other names 1

  • Mental Health & Addiction Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406000510 NY Part B Supplier - Clinic/Group Practice 7618960600 Receives reassigned benefits from 18 practitioners
Practice locations: Plattsburgh, NY

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Clinton County Health Department5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

130 Arizona Ave
Plattsburgh, NY 12903
Phone (518) 565-4060

18 Ampersand Dr
Plattsburgh, NY 12901
Phone (518) 565-4060

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clinton County Nursing HomePlattsburgh, NY, CCN 335598 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jan 1, 1978
Jan 1, 1978
Jan 1, 1978

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Clinton County
    • Skilled Nursing Facility
    • Plattsburgh, NY
    • NPI 1992854103

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 59

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 59

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1164465902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 ARIZONA AVE STE 1500",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129034908",
            "telephone_number": "518-565-4060",
            "fax_number": "518-566-0168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 ARIZONA AVE STE 1500",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129034908",
            "telephone_number": "518-565-4060",
            "fax_number": "518-566-0168"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18 Ampersand Dr",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129016500",
            "country_code": "US",
            "telephone_number": "518-566-0100",
            "fax_number": "518-566-0168",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLINTON COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "RICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF COMMUNITY SERVICES",
        "authorized_official_telephone_number": "518-565-4060"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "05727",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "685511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00672046",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mental Health & Addiction Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plattsburgh, NY

Sources for this page

Verify at the official NPI Registry.