Organization
GORHAM MENTAL HEALTH COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JILLEEN E GORHAM MS LMHC (OWNER)
(315) 559-4303
Entity
Organization
Contact information
Practice address
721 IDLEWOOD BLVD, BALDWINSVILLE, NY 13027-3010
(315) 559-4303
Mailing address
721 IDLEWOOD BLVD, BALDWINSVILLE, NY 13027-3010
(315) 559-4303
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164076097
—
NY
Enumeration date
06/19/2023
Last updated
06/19/2023
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