Provider Demographics
NPI:1407690308
Name:MEHLE, JESSE (MA, NCC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:MEHLE
Suffix:
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 INDUSTRIAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2287
Mailing Address - Country:US
Mailing Address - Phone:304-241-1854
Mailing Address - Fax:
Practice Address - Street 1:425 INDUSTRIAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2287
Practice Address - Country:US
Practice Address - Phone:304-241-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
WV725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool