Provider Demographics
NPI:1568884732
Name:MYC HOLDINGS LLC
Entity Type:Organization
Organization Name:MYC HOLDINGS LLC
Other - Org Name:HOLISTIC MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PCTL, SACIT
Authorized Official - Phone:414-847-6253
Mailing Address - Street 1:500 W SILVER SPRING DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5051
Mailing Address - Country:US
Mailing Address - Phone:414-847-6253
Mailing Address - Fax:414-501-2361
Practice Address - Street 1:500 W SILVER SPRING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5051
Practice Address - Country:US
Practice Address - Phone:414-847-6253
Practice Address - Fax:414-501-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health