Provider Demographics
NPI:1720863699
Name:HUNTINGTON MENTAL HEALTH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:HUNTINGTON MENTAL HEALTH ASSOCIATES, INC.
Other - Org Name:HUNTINGTON BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-523-1142
Mailing Address - Street 1:5044 NEWCOMB CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9704
Mailing Address - Country:US
Mailing Address - Phone:304-638-8329
Mailing Address - Fax:
Practice Address - Street 1:11713 ROUTE 152 STE 1
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-6539
Practice Address - Country:US
Practice Address - Phone:304-523-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUNTINGTON MENTAL HEALTH ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-29
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty