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General NPI Number Information
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NPI Number | 1194694661
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Entity Type | Organization
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Legal Business Name | MENTAL MIX THERAPY PLLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 20013 BLACKBURN ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1051
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Country | US
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Telephone | 313-380-0179
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Fax |
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Provider Business Mailing Address
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Address Line | 21366 HALL RD UNIT 4092
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1539
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Country | US
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Telephone | 313-380-0179
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | HAYLEY RENEE MINGER-MARLOW
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Credential | LMSW
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Telephone | 313-380-0179
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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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