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General NPI Number Information
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NPI Number | 1861340432
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Entity Type | Organization
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Legal Business Name | MOUNTAIN LAUREL PSYCHIATRY LLC
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 420 WATER ST
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1445
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Country | US
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Telephone | 601-941-8243
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 MIDDLETOWN COMMONS PMB 9600 SUITE 130
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City | WHITE HALL
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State | WV
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Zip | 26554
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Country | US
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Telephone | 601-941-8243
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | MARY HARPER
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Credential | PMHNP-BC
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Telephone | 601-941-8243
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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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