Provider Demographics
NPI:1760984868
Name:PINNACLE ENRICHMENT HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:PINNACLE ENRICHMENT HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:V
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PSYCHOLOGY
Authorized Official - Phone:901-270-8002
Mailing Address - Street 1:1300 MERCANTILE LN STE 150
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5334
Mailing Address - Country:US
Mailing Address - Phone:901-270-8002
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 150
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5334
Practice Address - Country:US
Practice Address - Phone:901-270-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMH-2462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty