Provider Demographics
NPI:1235011479
Name:MYRTLE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MYRTLE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-604-3012
Mailing Address - Street 1:1602 HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6015
Mailing Address - Country:US
Mailing Address - Phone:843-604-3012
Mailing Address - Fax:843-484-6118
Practice Address - Street 1:1500 HIGHWAY 17 N STE 101
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6079
Practice Address - Country:US
Practice Address - Phone:843-604-3012
Practice Address - Fax:843-484-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty