Provider Demographics
NPI:1902591514
Name:M & M THERAPEUTIC GROUP HOME, LLP
Entity Type:Organization
Organization Name:M & M THERAPEUTIC GROUP HOME, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC, CEO
Authorized Official - Prefix:
Authorized Official - First Name:FELECIA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:MODICUE
Authorized Official - Suffix:
Authorized Official - Credentials:CLINICAL DIRECTOR
Authorized Official - Phone:318-680-8414
Mailing Address - Street 1:617 TENNESSEE STREET
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232
Mailing Address - Country:US
Mailing Address - Phone:318-538-0600
Mailing Address - Fax:318-538-0602
Practice Address - Street 1:617 TENNESSEE STREET
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232
Practice Address - Country:US
Practice Address - Phone:318-538-0600
Practice Address - Fax:318-538-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities