Branch Out Mental Health Counseling PLLC

Key facts

NPI

1497564876

Entity type

Organization (NPI type 2)

Primary specialty

Mental Health Counselor 101YM0800X

Legal business name

BRANCH OUT MENTAL HEALTH COUNSELING PLLC

Practice address

186 White Pond Rd
Stormville, NY 12582-5719

Phone

(845) 768-2088

NPI assigned

Dec 31, 2024

Organization subpart

No

Authorized official

Name

Ms. Rebecca Wagner, LMHC NPI 1164033759

Title

Co-Owner

Phone

(914) 255-2075

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

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

• Rebecca Louise Wagner, LMHC-D Mental Health Counselor · Chappaqua, NY · NPI 1164033759
  NPD Authorized official MENTAL HEALTH

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 Jan 3, 2025.

{
    "created_epoch": "1735603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1497564876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 TARRYTOWN RD STE 1445",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106071313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 WHITE POND RD",
            "city": "STORMVILLE",
            "state": "NY",
            "postal_code": "125825719",
            "telephone_number": "845-768-2088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Sadore Ln Apt 5K",
            "address_purpose": "LOCATION",
            "city": "Yonkers",
            "state": "NY",
            "postal_code": "107104723",
            "country_code": "US",
            "telephone_number": "914-255-2075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRANCH OUT MENTAL HEALTH COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-31",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "914-255-2075",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Stormville, NY · Mental Health Counselor in New York