NPIMap

Organization Active NPI

Mountain Laurel Group LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Culpeper, VA
National Provider Identifier
1992853436
Registry record updated Jan 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
993-14-001 Issued in VA
Legal business name
MOUNTAIN LAUREL GROUP LLC
Practice address
102 N Main St Ste 300
Culpeper, VA 22701-3053
Phone
(540) 829-1789
Fax
(540) 829-0117
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2012

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

Authorized official

Name
Mr. Bruce C Wyman, LPC,NCC,EDM
Title
Director/Ceo
Phone
(540) 829-1789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 993-14-001 VA Primary

Addresses

Primary practice location

102 N Main St Ste 300
Culpeper, VA 22701-3053

Mailing address

102 N Main St Ste 300
Culpeper, VA 22701-3053
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.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1992853436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N MAIN ST STE 300",
            "city": "CULPEPER",
            "state": "VA",
            "postal_code": "227013053",
            "telephone_number": "540-829-1789",
            "fax_number": "540-829-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N MAIN ST STE 300",
            "city": "CULPEPER",
            "state": "VA",
            "postal_code": "227013053",
            "telephone_number": "540-829-1789",
            "fax_number": "540-829-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN LAUREL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "WYMAN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR/CEO",
        "authorized_official_telephone_number": "540-829-1789",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC,NCC,EDM"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "VA",
            "license": "993-14-001",
            "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 Jan 26, 2012; 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.