Provider Demographics
NPI:1992483366
Name:MBM PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:MBM PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-361-7097
Mailing Address - Street 1:3271 GONDOLA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1065
Mailing Address - Country:US
Mailing Address - Phone:859-361-7097
Mailing Address - Fax:
Practice Address - Street 1:3271 GONDOLA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1065
Practice Address - Country:US
Practice Address - Phone:859-361-7097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)