Provider Demographics
NPI:1891736724
Name:HUNTINGTON BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:HUNTINGTON BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-733-2229
Mailing Address - Street 1:3440 BLUE SULPHUR GDNS
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-9757
Mailing Address - Country:US
Mailing Address - Phone:304-733-2229
Mailing Address - Fax:304-733-2229
Practice Address - Street 1:1623 13TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3845
Practice Address - Country:US
Practice Address - Phone:304-526-2243
Practice Address - Fax:304-526-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV362103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0163332000Medicaid
WV0163332000Medicaid