Mmclinic, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MMCLINIC, LLC

Practice address

75 Manhattan Dr Ste 106
Boulder, CO 80303-4251

Phone

(303) 562-4128

NPI assigned

Sep 9, 2021

Last updated

Sep 9, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Alison McQueen, LPC

Title

Clinic Director

Phone

(303) 562-4128

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1831868272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 MANHATTAN DR STE 106",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034251",
            "telephone_number": "303-562-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 MANHATTAN DR STE 106",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034251",
            "telephone_number": "303-562-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMCLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "MCQUEEN",
        "authorized_official_first_name": "ALISON",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "303-562-4128",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Christopher Mitchell, BA
• Michiko Mitsunaga-Whitten, LCSW
• Mergen Alana Mittleider
• Aqui Mizrahi, L.AC
• Tal Liza Mizrahi, LPCC
• William Leslie Moats, LPC
• Edward Phillip Mockus, PHD
• Naomi Moddel, LCSW
• Janine Marie Moderski, MA, LPC
• Kelsie Modlich

• Mental Health Clinic/Center (Including Community Mental Health Center) in Boulder, CO
• Providers in Boulder, CO by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.