Provider Demographics
NPI:1972336139
Name:MACHEMEHL, MOLLY RUTH (MA LSSP)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:RUTH
Last Name:MACHEMEHL
Suffix:
Gender:F
Credentials:MA LSSP
Other - Prefix:MRS
Other - First Name:MOLLY
Other - Middle Name:RUTH
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDENTITY PROTECT
Mailing Address - Street 1:2332 AMHEARST LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4663
Mailing Address - Country:US
Mailing Address - Phone:469-554-8110
Mailing Address - Fax:866-984-3078
Practice Address - Street 1:2332 AMHEARST LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-4663
Practice Address - Country:US
Practice Address - Phone:469-554-8110
Practice Address - Fax:866-984-3078
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8069884103TS0200X
TX70196103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool