Natural Dystopia

Key facts

NPI

1275009490

Entity type

Organization (NPI type 2)

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Legal business name

NATURAL DYSTOPIA

Practice address

147 Ridge St Ste 2
Glens Falls, NY 12801-3216

Phone

(518) 480-7208

Fax

(844) 283-6959

NPI assigned

Oct 15, 2018

Organization subpart

No

Authorized official

Name

Akashia Ross

Title

Partner/Office Manager

Phone

(518) 586-4278

Practitioners 1

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

• Renee Katherine Larock-Gary, LMHC Mental Health Counselor · Ticonderoga, NY · NPI 1700360732
  NPD (past)

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 15, 2018.

{
    "created_epoch": "1539561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539561600000",
    "number": "1275009490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MOREHOUS DR",
            "city": "TICONDEROGA",
            "state": "NY",
            "postal_code": "128831110",
            "telephone_number": "518-586-4278",
            "fax_number": "844-283-6959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 RIDGE ST STE 2",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128013216",
            "telephone_number": "518-480-7208",
            "fax_number": "844-283-6959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATURAL DYSTOPIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-15",
        "last_updated": "2018-10-15",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "AKASHIA",
        "authorized_official_title_or_position": "PARTNER/OFFICE MANAGER",
        "authorized_official_telephone_number": "518-586-4278"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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