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General NPI Number Information
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NPI Number | 1003641358
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Entity Type | Organization
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Legal Business Name | MOMO LLC
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 162 GLENN PL
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City | LEXINGTON
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State | KY
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Zip | 40505-3519
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Country | US
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Telephone | 502-509-9436
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Fax |
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Provider Business Mailing Address
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Address Line | 743 E BROADWAY # 217
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City | LOUISVILLE
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State | KY
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Zip | 40202-1711
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MCCLAIN LEEDS OWENS
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Credential | LCSW
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Telephone | 502-509-9436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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