1972336139 NPI number — MS. MOLLY RUTH MACHEMEHL MA LSSP

Table of content: (NPI 1053389825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972336139 NPI number — MS. MOLLY RUTH MACHEMEHL MA LSSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACHEMEHL
Provider First Name:
MOLLY
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LSSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAHAM
Provider Other First Name:
MOLLY
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
IDENTITY PROTECT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972336139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2332 AMHEARST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-4663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-554-8110
Provider Business Mailing Address Fax Number:
866-984-3078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2332 AMHEARST LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-4663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-554-8110
Provider Business Practice Location Address Fax Number:
866-984-3078
Provider Enumeration Date:
08/22/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  8069884 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TS0200X , with the licence number: 70196 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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