| NPI | 1235737735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDAN STACK Owner, Lpc 518-610-4528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 1041C0700X Social Worker Clinical | |
| 235Z00000X Speech-Language Pathologist | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2025-08-03 |