Provider Demographics
NPI:1811607716
Name:MENDING MAPLE PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:MENDING MAPLE PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-840-1272
Mailing Address - Street 1:905 E CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4507
Mailing Address - Country:US
Mailing Address - Phone:712-840-1272
Mailing Address - Fax:
Practice Address - Street 1:905 E CLUB BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4507
Practice Address - Country:US
Practice Address - Phone:712-840-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health