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General NPI Number Information
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NPI Number | 1477349611
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Entity Type | Organization
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Legal Business Name | MAPLE GROVE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 711 E LEWIS AND CLARK PKWY STE 202
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City | CLARKSVILLE
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State | IN
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Zip | 47129-2283
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Country | US
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Telephone | 502-208-8441
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Fax |
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Provider Business Mailing Address
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Address Line | 711 E LEWIS AND CLARK PKWY STE 203
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City | CLARKSVILLE
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State | IN
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Zip | 47129-2283
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Country | US
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Telephone | 502-208-8441
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS A DIXON
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Credential | LMHC
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Telephone | 502-208-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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