| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 802 Oak St, Kenova, West Virginia |
| Authorized Official Name and Position | Rita M Vaughn (OWNER) |
| Authorized Official Contact | 6065472262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
802 Oak St Kenova WV 25530-1519 Ph: (304) 908-1056 | 802 Oak St Kenova WV 25530 Ph: (606) 547-2262 |
| NPI Number | 1043706484 |
|---|---|
| Provider Enumeration Date | 07/09/2018 |
| Last Update Date | 10/01/2024 |
| Certification Date | 10/01/2024 |
| Medicare PECOS PAC ID | 0143769851 |
|---|---|
| Medicare Enrollment ID | O20240826004310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043706484 | NPI | - | NPPES |
| 0331405 | Medicaid | OH | |
| 1043706484 | Medicaid | WV | |
| 71005559000 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 2182 (West Virginia) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Rita Vaughn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104047000 PECOS PAC ID: 1052850765 Enrollment ID: I20240830002811 |
Diversified Assessment & Therapy Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1401 Chestnut St, Kenova, WV 25530 Phone: 304-453-2800 | |
Above And Beyond:aba Therapy For Autism And More Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 716 Pine Hill Estates Rd, Kenova, WV 25530 Phone: 304-972-7628 |