Healthcare Provider Details

I. General information

NPI: 1356178131
Provider Name (Legal Business Name): ACTIVE MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4284 WILLIAM FLYNN HWY STE 101
ALLISON PARK PA
15101-1440
US

IV. Provider business mailing address

4284 WILLIAM FLYNN HWY STE 101
ALLISON PARK PA
15101-1440
US

V. Phone/Fax

Practice location:
  • Phone: 412-339-0599
  • Fax:
Mailing address:
  • Phone: 412-339-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHON C BAILLIE
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 412-339-0599