Organization
MARSHALL-JACKSON MENTAL HEALTH BD., INC.
Active
Other names
MT. LAKES BEHAVIORAL HEALTHCARE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MYRON GARGIS LCSW (INTERMIN EXECUTIVE DIRECTOR)
(256) 582-4240
Entity
Organization
Contact information
Practice address
2409 HOMER CLAYTON DR, GUNTERSVILLE, AL 35976-2207
(256) 582-3203
(256) 582-3216
Mailing address
2409 HOMER CLAYTON DR, GUNTERSVILLE, AL 35976-2207
(256) 582-3203
(256) 582-3216
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568495588
UBH PROVIDER
AL
05
—
330000013
—
AL
05
—
330034013
—
AL
01
—
510081221
BCBS ALLKIDS
AL
01
—
528400680
MCR/MCD CROSSOVER GROUP #
AL
05
—
590000013
—
AL
Enumeration date
07/10/2006
Last updated
10/18/2010
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