Healthcare Provider Details

I. General information

NPI: 1225738008
Provider Name (Legal Business Name): MM FAMILY CIRCLE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 BOSTON MILLS RD STE 400
HUDSON OH
44236-1193
US

IV. Provider business mailing address

3269 SUFFOLK DOWNS
STOW OH
44224
US

V. Phone/Fax

Practice location:
  • Phone: 614-975-2520
  • Fax:
Mailing address:
  • Phone: 614-975-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN G MANNELLA
Title or Position: PRESIDENT
Credential:
Phone: 614-975-2520