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General NPI Number Information
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NPI Number | 1366799561
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Entity Type | Organization
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Legal Business Name | YOUTH HEALTH SERVICE INC
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 971 HARRISON AVENUE YOUTH HEALTH SERVICE INC
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City | ELKINS
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State | WV
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Zip | 26241
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Country | US
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Telephone | 304-636-9450
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Fax | 304-636-2282
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Provider Business Mailing Address
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Address Line | 971 HARRISON AVENUE YOUTH HEALTH SERVICE INC
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City | ELKINS
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State | WV
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Zip | 26241
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Country | US
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Telephone | 304-636-9450
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Fax | 304-636-2282
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Authorized Official
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Title or Position | BILLING CLERK
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Name | MRS. BARBARA KAY KOON
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Credential |
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Telephone | 304-636-9450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | BP00944009
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License Number State | WV
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