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1740234673

NPI Code Detail

MEDICARE: SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER, INC.

MEDICARE: SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER, 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	101Y00000X	Counselor	019	WV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	019	WV
3	101YM0800X	Mental Health Counselor	019	WV
4	101YP2500X	Professional Counselor	019	WV
5	103TC0700X	Clinical Psychologist	019	WV
6	103TC1900X	Counseling Psychologist	019	WV
7	103TM1800X	Intellectual & Developmental Disabilities Psychologist	019	WV
8	103T00000X	Psychologist	019	WV
9	1041C0700X	Clinical Social Worker	0191	WV
10	106H00000X	Marriage & Family Therapist	019	WV
11	251S00000X	Community/Behavioral Health Agency	019	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740234673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	200 12TH STREET EXTENSION
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-2329
Country	:	US
Telephone Number	:	304-425-9541
Fax Number	:	304-431-2856

Provider Business Practice Location Address
First Line	:	200 12TH STREET EXTENSION
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-2329
Country	:	US
Telephone Number	:	304-425-9541
Fax Number	:	304-431-2856

Authorized Official
Title or Position	:	CHIEF EXECUTIVE DIRECTOR
Name	:	MS. JUDY L. AKERS
Credential	:	MS
Telephone Number	:	304-818-2200

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	09/14/2011

Similar Medicare Providers

1174402853 — MRS. KIMBERLY NICOLE HARDING-DUDDING FNP-BC
Practice Location Address:

200 12TH STREET EXT
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24740-2329

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Practice Fax:

1134160641 — OLGA M. HURT MSW
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1659312692 — TINA RENEE BORICH MA, LPC
Practice Location Address:

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PRINCETON, WV
24740-2329

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Practice Fax: 304-425-1332

1265473219 — RACHEL ANN ROMAS MA, LPC
Practice Location Address:

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PRINCETON, WV
24740-2329

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Practice Fax: 304-425-1332

1861433781 — MITCHELL JAY SAULS MSW / LGSW
Practice Location Address:

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1598709040 — MR. JAMES ARNOLD BAKER MSW/CCAC/LICSW
Practice Location Address:

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Directions to “SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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