Provider Demographics
NPI:1992458798
Name:GAINING GROUND MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:GAINING GROUND MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLMER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:937-479-0717
Mailing Address - Street 1:2604 ELMWOOD AVE STE 149
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2213
Mailing Address - Country:US
Mailing Address - Phone:585-507-4916
Mailing Address - Fax:332-345-2040
Practice Address - Street 1:225 BROADWAY STE 3400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3054
Practice Address - Country:US
Practice Address - Phone:585-507-4916
Practice Address - Fax:332-345-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty