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General NPI Number Information
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NPI Number | 1740160662
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Entity Type | Organization
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Legal Business Name | MDM CREATIVE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 140 AUBURN ST
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City | BRIDGEWATER
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State | MA
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Zip | 02324-3404
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Country | US
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Telephone | 857-244-4889
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Fax |
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Provider Business Mailing Address
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Address Line | 68 HARRISON AVE SUIT 605 #104061
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City | BOSTON
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State | MA
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Zip | 02111
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Country | US
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Telephone | 857-244-4889
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. MIAISHA MURRELL
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Credential | LMHC
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Telephone | 587-244-8449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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