Healthcare Provider Details

I. General information

NPI: 1619449352
Provider Name (Legal Business Name): BEACON BARN THERAPEUTIC FARM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 SANDY CREEK RD
THORNTON WV
26440-7614
US

IV. Provider business mailing address

1120 SANDY CREEK RD
THORNTON WV
26440-7614
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-0389
  • Fax:
Mailing address:
  • Phone: 304-265-0389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MOLLY MCCARTNEY
Title or Position: OWNER
Credential: MSW
Phone: 304-265-0389