MEDICARE: TALKING MAHLA INC MAHLA WOOD

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
1	101YM0800X	Mental Health Counselor	6401003039	MI

General Provider Information

NPI Number	:	1932613395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALKING MAHLA INC MAHLA WOOD

Provider Business Mailing Address
First Line	:	6199 MILLER RD
Second Line	:	SUITE A
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473
Country	:	US
Telephone Number	:	810-287-1047
Fax Number	:	810-630-0962

Provider Business Practice Location Address
First Line	:	6199 MILLER RD STE A
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1585
Country	:	US
Telephone Number	:	810-287-1047
Fax Number	:	810-630-0962

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAHLA WOOD
Credential	:	LPC
Telephone Number	:	810-287-1047

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	11/21/2017

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