Provider Demographics
NPI:1932702008
Name:TEACHWORTH, MAHRLEY (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:MAHRLEY
Middle Name:
Last Name:TEACHWORTH
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 W WILLOW HWY # 199
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1231
Mailing Address - Country:US
Mailing Address - Phone:517-588-6169
Mailing Address - Fax:
Practice Address - Street 1:6211 W WILLOW HWY # 199
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1231
Practice Address - Country:US
Practice Address - Phone:517-588-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health