Healthcare Provider Details

I. General information

NPI: 1720863699
Provider Name (Legal Business Name): HUNTINGTON MENTAL HEALTH ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11713 ROUTE 152 STE 1
WAYNE WV
25570-6539
US

IV. Provider business mailing address

1415 6TH AVE
HUNTINGTON WV
25701-2420
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-1142
  • Fax:
Mailing address:
  • Phone: 304-523-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL BLANKENSHIP
Title or Position: DIRECTOR OF REVENUE
Credential:
Phone: 304-523-1142