MEDICARE: KENTALA BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1093681942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTALA BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	7432 ALBAN STATION BLVD # 2226
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-2332
Country	:	US
Telephone Number	:	703-840-4457
Fax Number	:

Provider Business Practice Location Address
First Line	:	7432 ALBAN STATION BLVD # 2226
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-2332
Country	:	US
Telephone Number	:	703-840-4457
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN WYNN MURDOCK
Credential	:
Telephone Number	:	904-826-6213

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	03/25/2026

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