Provider Demographics
NPI:1841062031
Name:YOUR STORY MENTAL HEALTH COUNSELING, PLLC
Entity type:Organization
Organization Name:YOUR STORY MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:716-539-0041
Mailing Address - Street 1:4211 N BUFFALO RD STE 4
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2401
Mailing Address - Country:US
Mailing Address - Phone:716-539-0041
Mailing Address - Fax:
Practice Address - Street 1:4211 N BUFFALO RD STE 4
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2401
Practice Address - Country:US
Practice Address - Phone:716-539-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)