Club Mental Health Counseling Services, P.C.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

001024-1 Issued in NY

Legal business name

CLUB MENTAL HEALTH COUNSELING SERVICES, P.C.

Practice address

272 Ada Dr
Staten Island, NY 10314-1434

Phone

(718) 873-3189

Fax

(718) 982-8508

NPI assigned

Sep 23, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Leslie B Martin, LMHC

Title

President

Phone

(718) 873-3189

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285200000000",
    "number": "1982912929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 140695",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103140695",
            "telephone_number": "781-873-3189",
            "fax_number": "718-982-8508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 ADA DR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103141434",
            "telephone_number": "718-873-3189",
            "fax_number": "718-982-8508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB MENTAL HEALTH COUNSELING SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-23",
        "last_updated": "2010-09-23",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-873-3189",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "001024-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.