NPIMap

Organization Active NPI

Mountain State Psychological Services, PLLC

  • Intellectual & Developmental Disabilities Psychologist
  • Keyser, WV
National Provider Identifier
1326117409
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X
Legal business name
MOUNTAIN STATE PSYCHOLOGICAL SERVICES, PLLC
Practice address
130 Center St
Keyser, WV 26726-3520
Phone
(304) 788-1113
Fax
(304) 788-2777
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Sarah K Burke
Title
Director of Operations
Phone
(304) 788-1113

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Intellectual & Developmental Disabilities PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TM1800X Primary

Addresses

Primary practice location

130 Center St
Keyser, WV 26726-3520

Mailing address

130 Center St
Keyser, WV 26726-3520
Phone (304) 788-1113

Other identifiers 1

IdentifierTypeStateIssuer
3810006086MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041117000352 WV Part B Supplier - Clinic/Group Practice 8224092481 Receives reassigned benefits from 4 practitioners
Practice locations: Keyser, WV

National Provider Directory

National Provider Directory

Locations

130 Center St
Keyser, WV 26726
Phone (304) 788-1113

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1326117409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 CENTER ST",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "267263520",
            "telephone_number": "304-788-1113",
            "fax_number": "304-788-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CENTER ST",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "267263520",
            "telephone_number": "304-788-1113",
            "fax_number": "304-788-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE PSYCHOLOGICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BURKE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "304-788-1113"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006086",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Keyser, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.