| Mhjm Counseling Llc | |
|
4122 Wahl Street Blvd Ste 15 Louisville KY 40218-3265 | |
| (502) 640-9486 | |
| Not Available |
| Full Name | Mhjm Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 4122 Wahl Street Blvd Ste 15, Louisville, Kentucky |
| Authorized Official Name and Position | Miran H Mcclendon (OWNER) |
| Authorized Official Contact | 5028193138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mhjm Counseling Llc 12468 La Grange Rd # 322 Louisville KY 40245-1901 Ph: (502) 819-3138 | Mhjm Counseling Llc 4122 Wahl Street Blvd Ste 15 Louisville KY 40218-3265 Ph: (502) 640-9486 |
| NPI Number | 1477259117 |
|---|---|
| Provider Enumeration Date | 02/03/2023 |
| Last Update Date | 07/25/2024 |
| Certification Date | 07/25/2024 |
| Medicare PECOS PAC ID | 4688018963 |
|---|---|
| Medicare Enrollment ID | O20240214002156 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477259117 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Miran H. Mcclendon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871982926 PECOS PAC ID: 0941644223 Enrollment ID: I20240214002468 |
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