1972336139 NPI number — MS. MOLLY RUTH MACHEMEHL MA LSSP

Table of content: MS. MOLLY RUTH MACHEMEHL MA LSSP (NPI 1972336139)

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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