Provider Demographics
NPI:1851629323
Name:METRO MUSIC THERAPY, LLC
Entity Type:Organization
Organization Name:METRO MUSIC THERAPY, LLC
Other - Org Name:METRO MUSIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:REXROAD
Authorized Official - Last Name:EVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC, NICU MT
Authorized Official - Phone:404-579-8070
Mailing Address - Street 1:3316 CAMERON TRL
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3372
Mailing Address - Country:US
Mailing Address - Phone:404-579-8070
Mailing Address - Fax:
Practice Address - Street 1:3316 CAMERON TRL
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3372
Practice Address - Country:US
Practice Address - Phone:404-579-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-22
Last Update Date:2009-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08015171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty