Provider Demographics
NPI:1881608453
Name:WASHINGTON COUNTY MENTAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:WASHINGTON COUNTY MENTAL HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-229-1399
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-229-1399
Mailing Address - Fax:802-223-8623
Practice Address - Street 1:260 BECKLEY HILL RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-9080
Practice Address - Country:US
Practice Address - Phone:802-476-1480
Practice Address - Fax:802-479-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009759Medicaid
VT1006176Medicaid