Healthcare Provider Details

I. General information

NPI: 1285789537
Provider Name (Legal Business Name): LOGAN-MINGO AREA MENTAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 LMAH CENTER RD
LOGAN WV
25601-4058
US

IV. Provider business mailing address

PO BOX 176
LOGAN WV
25601-0176
US

V. Phone/Fax

Practice location:
  • Phone: 304-792-7130
  • Fax:
Mailing address:
  • Phone: 304-792-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number11
License Number StateWV

VIII. Authorized Official

Name: ANGELA LYNN ROBERTSON
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 304-792-7130