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General NPI Number Information
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NPI Number | 1235011479
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Entity Type | Organization
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Legal Business Name | MYRTLE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 1500 HIGHWAY 17 N STE 101
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-6079
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Country | US
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Telephone | 843-604-3012
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Fax | 843-484-6118
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Provider Business Mailing Address
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Address Line | 1602 HIGHWAY 17 N
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-6015
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Country | US
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Telephone | 843-604-3012
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Fax | 843-484-6118
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Authorized Official
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Title or Position | OWNER
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Name | HANNAH KLOCH
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Credential |
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Telephone | 843-604-3012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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