Organization
SMBM, LCSW, PLLC
Active
Other names
Adirondack Equine Assisted Psychotherapy, LCSW
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON BROCK MYLES LCSW (OWNER)
(518) 573-0239
Entity
Organization
Contact information
Practice address
46 REYNOLDS RD, FORT EDWARD, NY 12828-9244
(518) 573-0239
Mailing address
10 FOXHURST DR, QUEENSBURY, NY 12804-8488
(518) 573-0239
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
078314
NY
Other
Enumeration date
10/29/2013
Last updated
10/30/2013
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