Provider Demographics
NPI:1821453317
Name:MOUNTAINEER BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MOUNTAINEER BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:148-940-0407
Mailing Address - Street 1:55 MERIDIAN PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-5422
Mailing Address - Country:US
Mailing Address - Phone:304-901-2070
Mailing Address - Fax:304-901-4436
Practice Address - Street 1:55 MERIDIAN PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-5422
Practice Address - Country:US
Practice Address - Phone:304-901-2070
Practice Address - Fax:304-901-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2322-3006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty