| Logan-mingo Area Mental Health, Inc. | |
|
174 Lmah Center Rd Logan WV 25601-4058 | |
| (304) 792-7130 | |
| Not Available |
| Full Name | Logan-mingo Area Mental Health, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 174 Lmah Center Rd, Logan, West Virginia |
| Authorized Official Name and Position | Angela Lynn Robertson (BENEFITS COORDINATOR) |
| Authorized Official Contact | 3047927130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan-mingo Area Mental Health, Inc. Po Box 176 Logan WV 25601-0176 Ph: (304) 792-7130 | Logan-mingo Area Mental Health, Inc. 174 Lmah Center Rd Logan WV 25601-4058 Ph: (304) 792-7130 |
| NPI Number | 1346395035 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 01/30/2020 |
| Certification Date | 01/30/2020 |
| Medicare PECOS PAC ID | 0840240362 |
|---|---|
| Medicare Enrollment ID | O20050124000168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346395035 | NPI | - | NPPES |
| 0005460001 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 11 (West Virginia) | Primary |
| Provider Name | Valorie Ann Patrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336632157 PECOS PAC ID: 8426307489 Enrollment ID: I20180823003350 |
| Provider Name | Whitney Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760979777 PECOS PAC ID: 5991040313 Enrollment ID: I20181212003594 |
| Provider Name | Tiara Lyn Ferrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205550746 PECOS PAC ID: 9436514767 Enrollment ID: I20230420001347 |
| Provider Name | Zachary Isaac Dingess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699473959 PECOS PAC ID: 0345694691 Enrollment ID: I20230920004215 |
| Provider Name | Sandra Bernadine Vance |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174008239 PECOS PAC ID: 2264761451 Enrollment ID: I20240319000108 |
| Provider Name | Diana Alec Elkins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457115560 PECOS PAC ID: 9537500798 Enrollment ID: I20240518000655 |
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