Provider Demographics
NPI:1740160662
Name:MDM CREATIVE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:MDM CREATIVE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIAISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:587-244-8449
Mailing Address - Street 1:68 HARRISON AVE SUIT 605
Mailing Address - Street 2:#104061
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:857-244-4889
Mailing Address - Fax:
Practice Address - Street 1:140 AUBURN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3404
Practice Address - Country:US
Practice Address - Phone:857-244-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health