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General NPI Number Information
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NPI Number | 1255047759
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Entity Type | Organization
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Legal Business Name | BAYMARK HEALTH SERVICES OF WEST VIRGINIA, INC.
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 53 DON KNOTTS BLVD
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City | MORGANTOWN
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State | WV
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Zip | 26508-6838
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Country | US
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Telephone | 304-284-0025
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Fax | 304-284-0031
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Provider Business Mailing Address
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Address Line | 1720 LAKEPOINTE DR STE 117
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City | LEWISVILLE
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State | TX
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Zip | 75057-6425
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Country | US
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Telephone | 469-470-4779
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Fax | 214-481-7740
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Authorized Official
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Title or Position | VP, TREASURER
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Name | BRUCE JARVIE
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Credential |
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Telephone | 214-379-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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