Organization
MOTHERLAND COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY MUYUMBU (OWNER)
(520) 331-5287
Entity
Organization
Contact information
Practice address
3161 W CHERYL DR APT A16, PHOENIX, AZ 85051-2557
(520) 331-5287
Mailing address
10835 N 25TH AVE STE 125, PHOENIX, AZ 85029-3461
(520) 331-5287
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
08/09/2022
Last updated
12/06/2022
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