Provider Demographics
| NPI: | 1740234673 |
|---|---|
| Name: | SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER, INC. |
| Entity Type: | Organization |
| Organization Name: | SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER, INC. |
| Other - Org Name: | SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CHIEF EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | JUDY |
| Authorized Official - Middle Name: | L |
| Authorized Official - Last Name: | AKERS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MS |
| Authorized Official - Phone: | 304-818-2200 |
| Mailing Address - Street 1: | 200 12TH STREET EXTENSION |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PRINCETON |
| Mailing Address - State: | WV |
| Mailing Address - Zip Code: | 24740-2329 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 304-425-9541 |
| Mailing Address - Fax: | 304-431-2856 |
| Practice Address - Street 1: | 200 12TH STREET EXTENSION |
| Practice Address - Street 2: | |
| Practice Address - City: | PRINCETON |
| Practice Address - State: | WV |
| Practice Address - Zip Code: | 24740-2329 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 304-425-9541 |
| Practice Address - Fax: | 304-431-2856 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-22 |
| Last Update Date: | 2011-09-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| WV | 019 | 101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 103T00000X, 103TC0700X, 103TC1900X, 103TM1800X, 106H00000X, 251S00000X |
| WV | 0191 | 1041C0700X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WV | 0005489002 | Medicaid | |
| WV | 0005489000 | Medicaid | |
| WV | 0005489001 | Medicaid | |
| WV | 0005489000 | Medicaid | |
| WV | 0005489001 | Medicaid | |
| WV | 0005489002 | Medicaid |
