Healthcare Provider Details

I. General information

NPI: 1396166302
Provider Name (Legal Business Name): PREMIER MENTAL HEALTH CARE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 MARKET ST SUITE # 102
CAMP HILL PA
17011-4412
US

IV. Provider business mailing address

3461 MARKET ST SUITE # 102
CAMP HILL PA
17011-4412
US

V. Phone/Fax

Practice location:
  • Phone: 717-695-7825
  • Fax: 717-695-7843
Mailing address:
  • Phone: 717-695-7825
  • Fax: 717-695-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD419076
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BENYAM G TEGENE
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 717-695-7825