Healthcare Provider Details

I. General information

NPI: 1871899955
Provider Name (Legal Business Name): MGM FAMILY COUNSELING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 THE HILL
PORTSMOUTH NH
03801
US

IV. Provider business mailing address

361 OCEAN RD
PORTSMOUTH NH
03801-6020
US

V. Phone/Fax

Practice location:
  • Phone: 978-697-9213
  • Fax: 603-617-3410
Mailing address:
  • Phone: 978-697-9213
  • Fax: 603-617-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119
License Number StateNH

VIII. Authorized Official

Name: MR. MICHAEL GEORGE MCCAY
Title or Position: OWNER
Credential: LMFT
Phone: 978-697-9213