Provider Demographics
NPI:1679708721
Name:MENTAL HEALTH PROVIDER SERVICES LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH PROVIDER SERVICES LLC
Other - Org Name:MHPS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-500-0087
Mailing Address - Street 1:259 N KELLY ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5209
Mailing Address - Country:US
Mailing Address - Phone:704-500-0087
Mailing Address - Fax:704-500-2720
Practice Address - Street 1:259 N KELLY ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5209
Practice Address - Country:US
Practice Address - Phone:704-500-0087
Practice Address - Fax:704-500-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty