MEDICARE: MOUNTAIN STATE PSYCHOLOGICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103T00000X	Psychologist
3	103TM1800X	Intellectual & Developmental Disabilities Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326117409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN STATE PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	130 CENTER ST
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-3520
Country	:	US
Telephone Number	:	304-788-1113
Fax Number	:	304-788-2777

Provider Business Practice Location Address
First Line	:	130 CENTER ST
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-3520
Country	:	US
Telephone Number	:	304-788-1113
Fax Number	:	304-788-2777

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	SARAH K BURKE
Credential	:
Telephone Number	:	304-788-1113

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	09/11/2025

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