Tyree Bernard Smith
Individual provider Active NPI Mental Health Counselor · Alexandria Bay, NY
NPI 1760156236 · NPPES record last updated Aug 6, 2021
Key facts
- NPI
- 1760156236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 111309-01 (NY)
- Practice address
- 4 Fuller St
Alexandria Bay, NY 13607-1391 - Phone
- (315) 482-1138
- NPI assigned
- Aug 6, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111309-01 | NY | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 111309-01 | NY | Yes |
Addresses
Primary practice location
4 Fuller St
Alexandria Bay, NY 13607-1391
Mailing address
31481 County Route 30
Philadelphia, NY 13673-3204
Phone (315) 481-6046
Other providers in Alexandria Bay, NY
- Seaway Radiology PC
- Sharon Lynn Segouin
- Natalie Anne Shea
- Cynthia Lee Simpson
- Jessica Michelle Smith
- Susan Stewart
- James Robert Tague
- Evelyn Rose Vento
- Alexandra B Warneck
- Allison Williams
All providers in Alexandria Bay, NY · Mental Health Counselor in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.