Provider Demographics
NPI:1932613395
Name:TALKING MAHLA INC MAHLA WOOD
Entity type:Organization
Organization Name:TALKING MAHLA INC MAHLA WOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:810-287-1047
Mailing Address - Street 1:6199 MILLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473
Mailing Address - Country:US
Mailing Address - Phone:810-287-1047
Mailing Address - Fax:810-630-0962
Practice Address - Street 1:6199 MILLER RD STE A
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1585
Practice Address - Country:US
Practice Address - Phone:810-287-1047
Practice Address - Fax:810-630-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty