Provider Demographics
NPI:1831868272
Name:MMCLINIC, LLC
Entity type:Organization
Organization Name:MMCLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-562-4128
Mailing Address - Street 1:75 MANHATTAN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4251
Mailing Address - Country:US
Mailing Address - Phone:303-562-4128
Mailing Address - Fax:
Practice Address - Street 1:75 MANHATTAN DR STE 106
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4251
Practice Address - Country:US
Practice Address - Phone:303-562-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)