| N/a | |
|
416 Mcclennan Dr Fayetteville NY 13066-1241 | |
| (716) 867-4251 | |
| Not Available |
| Full Name | N/a |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 416 Mcclennan Dr, Fayetteville, New York |
| Authorized Official Name and Position | Alexis James (OWNER) |
| Authorized Official Contact | 9044045400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 2363 James St # 652 Syracuse NY 13206-2840 Ph: (904) 404-5400 | N/a 416 Mcclennan Dr Fayetteville NY 13066-1241 Ph: (716) 867-4251 |
| NPI Number | 1720633779 |
|---|---|
| Provider Enumeration Date | 08/06/2019 |
| Last Update Date | 05/17/2021 |
| Certification Date | 05/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720633779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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