Organization
LOGAN MINGO AREA MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA LYNN ROBERTSON (BENEFITS COORDINATOR)
(304) 792-7130
Entity
Organization
Contact information
Practice address
174 LMAH CENTER RD, LOGAN, WV 25601-4058
(304) 792-7130
(304) 792-7138
Mailing address
PO BOX 176, LOGAN, WV 25601-0176
(304) 792-7130
(304) 792-7138
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
11
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005460000
—
WV
05
—
0005460001
—
WV
05
—
0005460002
—
WV
Enumeration date
05/14/2008
Last updated
01/30/2020
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