Provider Demographics
NPI:1689184467
Name:MOUNTAINEER MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:MOUNTAINEER MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-288-4259
Mailing Address - Street 1:285 W BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1610
Mailing Address - Country:US
Mailing Address - Phone:304-359-2380
Mailing Address - Fax:
Practice Address - Street 1:285 W BIRCH LN
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1610
Practice Address - Country:US
Practice Address - Phone:304-359-2380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV12094132Medicaid
WV861035573Medicaid