Provider Demographics
NPI:1124706791
Name:MKM HOLDINGS, INC
Entity type:Organization
Organization Name:MKM HOLDINGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-799-9719
Mailing Address - Street 1:501 ISLINGTON ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5346
Mailing Address - Country:US
Mailing Address - Phone:760-799-9719
Mailing Address - Fax:
Practice Address - Street 1:501 ISLINGTON ST STE 2D
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5346
Practice Address - Country:US
Practice Address - Phone:760-799-9719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty