Provider Demographics
NPI:1720506173
Name:MBH HIGHLAND, LLC
Entity Type:Organization
Organization Name:MBH HIGHLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-348-1421
Mailing Address - Street 1:PO BOX 4107
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25364-4107
Mailing Address - Country:US
Mailing Address - Phone:304-926-1600
Mailing Address - Fax:304-926-1642
Practice Address - Street 1:300 56TH ST SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2308
Practice Address - Country:US
Practice Address - Phone:304-926-1669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty