Provider Demographics
NPI:1114633773
Name:MUSTARD SEED COUNSELING AND BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MUSTARD SEED COUNSELING AND BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PHARES
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:304-409-8128
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-0694
Mailing Address - Country:US
Mailing Address - Phone:304-409-8128
Mailing Address - Fax:
Practice Address - Street 1:2030 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9737
Practice Address - Country:US
Practice Address - Phone:304-964-9714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty