Mountain Rooted Behavioral Health LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

MOUNTAIN ROOTED BEHAVIORAL HEALTH LLC

Practice address

106 Lockheed Dr
Beaver, WV 25813-8962

Phone

(304) 253-5155

Fax

(681) 207-7011

NPI assigned

Apr 1, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Victor M Rendon, DONPI 1720641368

Title

Owner

Phone

(304) 731-0991

Specialties & licenses 1

Addresses

Other names 1

• Mountain Rooted Behavioral Health Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Victor Michael Rendon, DO

  • Psychiatry Physician
  • Wilmington, DE
  • NPI 1720641368
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1073364469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 91",
            "city": "HOCKESSIN",
            "state": "DE",
            "postal_code": "197070091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 LOCKHEED DR",
            "city": "BEAVER",
            "state": "WV",
            "postal_code": "258138962",
            "telephone_number": "304-253-5155",
            "fax_number": "681-207-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN ROOTED BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "RENDON",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-731-0991",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Rooted Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James T Miller
• Leighann Mills
• Randi Renee Mocnik
• Myriah Montgomery
• Zackary David Morris
• Angela Marie Mullens
• Tina Mullins, MA
• Brandy Musick-Stover, BS
• Shannon Elise Nathan
• Daniel Lee Oglesby

• Psychiatry Physician in Beaver, WV
• Providers in Beaver, WV by specialty
• Psychiatry Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.