Healthcare Provider Details

I. General information

NPI: 1972038032
Provider Name (Legal Business Name): MLM THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 CANAL ST 204
NEW ORLEANS LA
70119-5848
US

IV. Provider business mailing address

4919 CANAL ST 204
NEW ORLEANS LA
70119-5848
US

V. Phone/Fax

Practice location:
  • Phone: 504-723-0881
  • Fax:
Mailing address:
  • Phone: 504-723-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number7575
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number7575
License Number StateLA

VIII. Authorized Official

Name: MARY LEE MULLER
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 504-723-0881