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General NPI Number Information
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NPI Number | 1962225961
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Entity Type | Organization
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Legal Business Name | MJG SERVICES LLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 101 W KIRKWOOD AVE STE 236E
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6129
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Country | US
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Telephone | 812-319-7376
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 S BRYAN ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-3612
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Country | US
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Telephone | 812-319-7376
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | KATHERINE GLASER
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Credential | LCSW
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Telephone | 812-319-7376
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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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