Healthcare Provider Details

I. General information

NPI: 1124275300
Provider Name (Legal Business Name): YOUTH HEALTH SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 HARRISON AVENUE
ELKINS WV
26241
US

IV. Provider business mailing address

971 HARRISON AVENUE
ELKINS WV
26241
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-9450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number18352
License Number StateWV

VIII. Authorized Official

Name: MARGY BURNS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-636-9450