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General NPI Number Information
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NPI Number | 1154840247
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Entity Type | Organization
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Legal Business Name | MLC THERAPY LLC
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 810 FIREWEED DR
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City | HENDERSON
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State | NV
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Zip | 89002-9105
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Country | US
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Telephone | 913-562-8880
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Fax | 702-445-6075
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Provider Business Mailing Address
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Address Line | 810 FIREWEED DRIVE
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City | HENDERSON
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State | NV
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Zip | 89002
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Country | US
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Telephone | 913-562-8880
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Fax | 702-445-6075
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARIE L COOK
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Credential | LCSW
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Telephone | 913-562-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4509
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License Number State | KS
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