Provider Demographics
NPI:1578236311
Name:MOUNTAIN STATE COUNSELING AND BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MOUNTAIN STATE COUNSELING AND BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:304-224-5410
Mailing Address - Street 1:455 ELAINE ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3761
Mailing Address - Country:US
Mailing Address - Phone:304-266-0847
Mailing Address - Fax:
Practice Address - Street 1:243 THREE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3839
Practice Address - Country:US
Practice Address - Phone:304-224-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty