MEDICARE: MYRTLE MENTAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1235011479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYRTLE MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1602 HIGHWAY 17 N
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6015
Country	:	US
Telephone Number	:	843-604-3012
Fax Number	:	843-484-6118

Provider Business Practice Location Address
First Line	:	1500 HIGHWAY 17 N STE 101
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6079
Country	:	US
Telephone Number	:	843-604-3012
Fax Number	:	843-484-6118

Authorized Official
Title or Position	:	OWNER
Name	:	HANNAH KLOCH
Credential	:
Telephone Number	:	843-604-3012

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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