Provider Demographics
NPI:1871899955
Name:MGM FAMILY COUNSELING CENTER PLLC
Entity type:Organization
Organization Name:MGM FAMILY COUNSELING CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MCCAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:978-697-9213
Mailing Address - Street 1:361 OCEAN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6020
Mailing Address - Country:US
Mailing Address - Phone:978-697-9213
Mailing Address - Fax:603-617-3410
Practice Address - Street 1:405 THE HILL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:978-697-9213
Practice Address - Fax:603-617-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30427247Medicaid