| Genesis Youth Crisis Center | |
|
535 Horner Ave Clarksburg WV 26301-3616 | |
| (304) 622-1907 | |
| (304) 623-9346 |
| Full Name | Genesis Youth Crisis Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 535 Horner Ave, Clarksburg, West Virginia |
| Authorized Official Name and Position | Matt Rudder (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3046221907 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Youth Crisis Center 535 Horner Ave Clarksburg WV 26301-3616 Ph: (304) 622-1907 | Genesis Youth Crisis Center 535 Horner Ave Clarksburg WV 26301-3616 Ph: (304) 622-1907 |
| NPI Number | 1821206715 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821206715 | NPI | - | NPPES |
| 0158712001 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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