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NPI Code Detail

MEDICARE: MOTHERLAND COUNSELING, LLC

MEDICARE: MOTHERLAND COUNSELING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QM0850XAdult Mental Health Clinic/Center
4324500000XSubstance Abuse Rehabilitation Facility
5251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1720716608
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOTHERLAND COUNSELING, LLC
Provider Business Mailing Address
First Line : 10835 N 25TH AVE STE 125
Second Line :
City : PHOENIX
State : AZ
Zip : 85029-3461
Country : US
Telephone Number : 520-331-5287
Fax Number :
Provider Business Practice Location Address
First Line : 3161 W CHERYL DR APT A16
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-2557
Country : US
Telephone Number : 520-331-5287
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JIMMY MUYUMBU
Credential :
Telephone Number : 520-331-5287
Provider Enumeration Date : 08/09/2022
Last Update Date : 12/06/2022

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Directions to “MOTHERLAND COUNSELING, LLC ” Practice Location

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