Organization · NPI-2

Intensive Trauma Recovery LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Morgantown, WV

NPI number1386218048
StatusActive
Last updated in NPPESMay 18, 2021

Details

NPI
1386218048
Entity type
Organization (NPI-2)
Legal business name
Intensive Trauma Recovery LLC
Organization subpart
No
Enumeration date
May 18, 2021
Certification date
Apr 17, 2021
Last updated
May 18, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Practice location

1102 About Town Place
Morgantown, WV 26508

Phone 800-755-6105 · Fax 800-755-6105

Mailing address

364 Patteson Dr # 105
Morgantown, WV 26505-3202

Phone 773-230-2310

Authorized official

Mary Jeanne Carlson
Ceo
7732302310

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