Provider Demographics
NPI:1588135479
Name:KELLY D. MAYER LMHC PLLC
Entity type:Organization
Organization Name:KELLY D. MAYER LMHC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:607-662-4141
Mailing Address - Street 1:6 N WEST ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1068
Mailing Address - Country:US
Mailing Address - Phone:607-662-4141
Mailing Address - Fax:607-662-4006
Practice Address - Street 1:6 N WEST ST STE 5
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1068
Practice Address - Country:US
Practice Address - Phone:607-662-4141
Practice Address - Fax:607-662-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008507-1OtherLICENCE NUMBER