Basic Information
| Provider Information | |||||||||
| NPI: | 1740294610 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLAND BEHAVIORAL HEALTH SVCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 PRESIDIO POINTE | ||||||||
| Address2: | |||||||||
| City: | CROSS LANES | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253131537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043691930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 HUMAN SERVICE COMPLEX | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250539678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043691930 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MUNDY | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | RISK MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 3049261600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | 21257 | WV | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
ID Information
| ID | Type | State | Issuer | Description | 3004199000 | 05 | WV | MEDICAID |