NPIMap

Organization Active NPI

Mountain Laurel Group, LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Culpeper, VA
National Provider Identifier
1750596441
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
MOUNTAIN LAUREL GROUP, LLC
Practice address
16126 Brandy Rd
Culpeper, VA 22701-4622
Phone
(540) 829-1789
Fax
(540) 825-4617
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Authorized official

Name
Mr. Bruce Charles Wyman, LPC
Title
Ceo
Phone
(540) 829-1789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

16126 Brandy Rd
Culpeper, VA 22701-4622

Mailing address

PO Box 507
Culpeper, VA 22701-0507
Phone (540) 829-1789

National Provider Directory

National Provider Directory
Tax ID family
Mountain Laurel Group LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

16126 Brandy Rd
Culpeper, VA 22701
Phone (540) 829-1789

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1750596441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 507",
            "city": "CULPEPER",
            "state": "VA",
            "postal_code": "227010507",
            "telephone_number": "540-829-1789",
            "fax_number": "540-825-4617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16126 BRANDY RD",
            "city": "CULPEPER",
            "state": "VA",
            "postal_code": "227014622",
            "telephone_number": "540-829-1789",
            "fax_number": "540-825-4617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN LAUREL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "WYMAN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "540-829-1789",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Culpeper, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; 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.