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General NPI Number Information
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NPI Number | 1790080307
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Entity Type | Organization
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Legal Business Name | MIDLAND BEHAVIORAL HEALTH, INC.
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 3450 RT. 60 EAST
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1609
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Country | US
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Telephone | 304-955-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 RT. 60 EAST
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1609
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Country | US
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Telephone | 304-955-6300
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT HANSEN
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Credential |
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Telephone | 304-399-1133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1213
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 71510
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 14902
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License Number State | WV
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