MEDICARE: WIRT COUNTY HEALTH SERVICES ASSOCIATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1710824735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIRT COUNTY HEALTH SERVICES ASSOCIATION INC

Provider Business Mailing Address
First Line	:	PO BOX 609
Second Line	:
City	:	ELIZABETH
State	:	WV
Zip	:	26143-0609
Country	:	US
Telephone Number	:	304-275-3301
Fax Number	:	304-275-4798

Provider Business Practice Location Address
First Line	:	209 58TH ST
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2027
Country	:	US
Telephone Number	:	304-420-9544
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROB DUDLEY
Credential	:
Telephone Number	:	304-861-4100

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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