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General NPI Number Information
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NPI Number | 1225738008
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Entity Type | Organization
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Legal Business Name | MM FAMILY CIRCLE INCORPORATED
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 581 BOSTON MILLS RD STE 400
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City | HUDSON
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State | OH
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Zip | 44236-1193
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Country | US
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Telephone | 614-975-2520
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Fax |
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Provider Business Mailing Address
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Address Line | 3269 SUFFOLK DOWNS
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City | STOW
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State | OH
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Zip | 44224
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Country | US
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Telephone | 614-975-2520
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN G MANNELLA
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Credential |
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Telephone | 614-975-2520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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