Provider Demographics
NPI:1689185704
Name:BANYAN TREE COUNSELING GROUP
Entity Type:Organization
Organization Name:BANYAN TREE COUNSELING GROUP
Other - Org Name:MORGANTOWN COUNSELING CENTER, MPCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, RN, NCC
Authorized Official - Phone:304-626-5824
Mailing Address - Street 1:686 WESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2418
Mailing Address - Country:US
Mailing Address - Phone:304-626-5824
Mailing Address - Fax:
Practice Address - Street 1:1063 MAPLE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0387
Practice Address - Country:US
Practice Address - Phone:304-626-5824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty