NPIMap

Organization Active NPI

Logan-Mingo Area Mental Health, Inc

Doing business as Mountain Laurel Integrated Healthcare

  • Federally Qualified Health Center (FQHC)
  • Logan, WV
National Provider Identifier
1598396202
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LOGAN-MINGO AREA MENTAL HEALTH, INC
Doing business as
Mountain Laurel Integrated Healthcare
Practice address
174 Lmah Center Rd
Logan, WV 25601-4058
Phone
(304) 792-7130
Fax
(304) 896-5184
NPI assigned
Jan 31, 2020
Last updated
Sep 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Authorized official

Name
Angela Lynn Robertson
Title
Benefits Coordinator
Phone
(304) 792-7130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

174 Lmah Center Rd
Logan, WV 25601-4058

Mailing address

PO Box 176
Logan, WV 25601-0176
Phone (304) 792-7130

Other names 1

  • Mountain Laurel Integrated Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200429002732 WV Part A Provider - Federally Qualified Health Center (FQHC) 0840240362 Practice locations: Logan, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598396202. Details of each certification follow.

Federally qualified health center certification: CCN 511183

Legal name
LOGAN-MINGO AREA MENTAL HEALTH INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2020
Last certification
Mar 16, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 15, 1970 in WV
Enrollment address
174 Lmah Center Rd
Logan, WV 25601-4058

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Logan Mingo Area Mental Health Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

174 Lmah Center Rd
#176
Logan, WV 25601
Phone 30479271301027

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dianna Maynard Individual Corporate OfficerTreasurer Jul 1, 2025
Donna J Cooke Individual Contracted Managing Employee Mar 25, 2013
Corporate OfficerChief Executive Officer Mar 25, 2013
Corporate Director Mar 25, 2013
W-2 Managing Employee Mar 25, 2013
Operational/Managerial Control Mar 25, 2013
Dana Wright Individual Corporate Officer2ND Vice President Jul 1, 2025
Ann Athey Individual Corporate OfficerSecretary Jul 1, 2025
Rebecca Cook Individual Corporate OfficerPresident Jul 1, 2025
Judy Hamrick Individual Corporate OfficerVice President Jul 1, 2025

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788393600000",
    "number": "1598396202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 176",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256010176",
            "telephone_number": "304-792-7130",
            "fax_number": "304-896-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 LMAH CENTER RD",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014058",
            "telephone_number": "304-792-7130",
            "fax_number": "304-896-5184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN-MINGO AREA MENTAL HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-31",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BENEFITS COORDINATOR",
        "authorized_official_telephone_number": "304-792-7130"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Laurel Integrated Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Logan, WV

Sources for this page

Verify at the official NPI Registry.