Organization
EIDOLON THERAPEUTIC COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDBRICK BUSH LCSW (OWNER)
(646) 460-2543
Entity
Organization
Contact information
Practice address
10 PARK AVE, NEW YORK, NY 10016-4338
(646) 460-2543
Mailing address
10 PARK AVE, NEW YORK, NY 10016-4338
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/19/2023
Last updated
04/19/2023
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