Healthcare Provider Details

I. General information

NPI: 1962060053
Provider Name (Legal Business Name): XYLEM HOUSE COUNSELING AND PLAY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2769 COLLIS AVE
HUNTINGTON WV
25702-1318
US

IV. Provider business mailing address

149 9TH AVE
HUNTINGTON WV
25701-2707
US

V. Phone/Fax

Practice location:
  • Phone: 681-204-3693
  • Fax:
Mailing address:
  • Phone: 304-972-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE COMER
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 304-972-5789