Provider Demographics
NPI:1942000922
Name:MULBERRY STREET MANAGEMENT SERVICES, INC
Entity type:Organization
Organization Name:MULBERRY STREET MANAGEMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-291-9066
Mailing Address - Street 1:1097 GREENBAG RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1532
Mailing Address - Country:US
Mailing Address - Phone:304-291-9066
Mailing Address - Fax:
Practice Address - Street 1:1097 GREENBAG RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1532
Practice Address - Country:US
Practice Address - Phone:304-291-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULBERRY STREET MANAGEMENT SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health