| Momo LLC | |
|
162 Glenn Pl Lexington KY 40505-3519 | |
| (502) 509-9436 | |
| Not Available |
| Full Name | Momo LLC |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 162 Glenn Pl, Lexington, Kentucky |
| Authorized Official Name and Position | Mcclain Leeds Owens (OWNER) |
| Authorized Official Contact | 5025099436 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Momo LLC 743 E Broadway # 217 Louisville KY 40202-1711 | Momo LLC 162 Glenn Pl Lexington KY 40505-3519 Ph: (502) 509-9436 |
| NPI Number | 1003641358 |
|---|---|
| Provider Enumeration Date | 09/05/2024 |
| Last Update Date | 09/05/2024 |
| Certification Date | 09/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003641358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (NU) | Primary |
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