Provider Demographics
NPI:1588686596
Name:TOMPKINS COUNTY MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:TOMPKINS COUNTY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-274-6200
Mailing Address - Street 1:201 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5421
Mailing Address - Country:US
Mailing Address - Phone:607-274-6305
Mailing Address - Fax:607-274-6316
Practice Address - Street 1:201 E GREEN ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5421
Practice Address - Country:US
Practice Address - Phone:607-274-6305
Practice Address - Fax:607-274-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6892300A261QM0801X
NY6892100A261QM0801X
NY6892020A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000147759OtherEXCELLUS
NY00357891Medicaid
012251OtherVALUE OPTIONS
NY55750AMedicare PIN