Provider Demographics
NPI:1073354395
Name:PREMIERE MENTAL HEALTH & BEHAVIORAL MEDICINE LLC
Entity type:Organization
Organization Name:PREMIERE MENTAL HEALTH & BEHAVIORAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:304-786-1222
Mailing Address - Street 1:600 SOUTH CHURCH ST
Mailing Address - Street 2:STE 3
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1666
Mailing Address - Country:US
Mailing Address - Phone:304-786-1222
Mailing Address - Fax:304-786-1236
Practice Address - Street 1:600 SOUTH CHURCH ST STE 3
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1666
Practice Address - Country:US
Practice Address - Phone:304-786-1222
Practice Address - Fax:304-786-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty