Healthcare Provider Details

I. General information

NPI: 1992296453
Provider Name (Legal Business Name): MLH PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 MAIN ST STE 2
HELLERTOWN PA
18055-1721
US

IV. Provider business mailing address

427 MAIN ST STE 2
HELLERTOWN PA
18055-1721
US

V. Phone/Fax

Practice location:
  • Phone: 855-414-2523
  • Fax:
Mailing address:
  • Phone: 855-414-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number018424
License Number StatePA

VIII. Authorized Official

Name: DR. MICHELLE HOBBY
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 855-414-2523