Provider Demographics
NPI:1730574013
Name:ADULT AND YOUTH SERVICES, P.L.L.C.
Entity type:Organization
Organization Name:ADULT AND YOUTH SERVICES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:304-257-8232
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:WV
Mailing Address - Zip Code:26260-0044
Mailing Address - Country:US
Mailing Address - Phone:304-257-8232
Mailing Address - Fax:304-636-4200
Practice Address - Street 1:1200 HARRISON AVE.
Practice Address - Street 2:SUITE 121
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3392
Practice Address - Country:US
Practice Address - Phone:304-636-4200
Practice Address - Fax:304-636-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV999103TC0700X
WV2304-8074103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810017759Medicaid