Provider Demographics
NPI:1659084176
Name:MB THERAPY, PLLC
Entity Type:Organization
Organization Name:MB THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHOF
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-214-3450
Mailing Address - Street 1:2750 1ST AVE NE, STE 125-D
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4831
Mailing Address - Country:US
Mailing Address - Phone:319-214-3450
Mailing Address - Fax:
Practice Address - Street 1:2750 1ST AVE NE, STE 125-D
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4831
Practice Address - Country:US
Practice Address - Phone:319-214-3450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)