Organization
INTENSIVE TRAUMA RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JEANNE CARLSON (CEO)
(773) 230-2310
Entity
Organization
Contact information
Practice address
1102 ABOUT TOWN PLACE, MORGANTOWN, WV 26508
(800) 755-6105
(800) 755-6105
Mailing address
364 PATTESON DR # 105, MORGANTOWN, WV 26505-3202
(773) 230-2310
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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