Healthcare Provider Details

I. General information

NPI: 1518785831
Provider Name (Legal Business Name): M AND M DEVELOPMENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 WILDWOOD LN
WHITEHOUSE OH
43571-9527
US

IV. Provider business mailing address

5901 WILDWOOD LN
WHITEHOUSE OH
43571-9527
US

V. Phone/Fax

Practice location:
  • Phone: 567-644-2317
  • Fax:
Mailing address:
  • Phone: 567-644-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MACKENZIE MULLINS
Title or Position: MANAGING PARTNER
Credential:
Phone: 567-644-2317