Healthcare Provider Details

I. General information

NPI: 1962641357
Provider Name (Legal Business Name): MM UNLIMITED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 FLORIN RD STE 26/12
SACRAMENTO CA
95823-1800
US

IV. Provider business mailing address

3811 FLORIN RD STE 26
SACRAMENTO CA
95823-1822
US

V. Phone/Fax

Practice location:
  • Phone: 916-421-1184
  • Fax: 916-421-1188
Mailing address:
  • Phone: 916-421-1184
  • Fax: 916-421-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberA62263
License Number StateCA

VIII. Authorized Official

Name: DENNIS EUGENE SLIDER
Title or Position: CEO
Credential:
Phone: 916-421-1184