NPIMap

Organization Active NPI

Genesis Youth Crisis Center, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Clarksburg, WV
National Provider Identifier
1255081675
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
GENESIS YOUTH CRISIS CENTER, INC.
Practice address
591 Pressley Ridge Rd
Clarksburg, WV 26301-7024
Phone
(304) 709-7020
Fax
(681) 399-9115
NPI assigned
Mar 28, 2022
Organization subpart
Yes
Parent organization
GENESIS YOUTH CRISIS CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Scott Mayer, BA, LSW
Title
Cqi Specialist
Phone
(304) 622-1907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

591 Pressley Ridge Rd
Clarksburg, WV 26301-7024

Mailing address

192 Safe Haven Dr
Clarksburg, WV 26301-9103
Phone (304) 622-1907

Other names 1

  • Diagnostic at Laurel Park Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Genesis Youth Crisis Center Inc5 organizations share this tax ID, including this one
Part of
Genesis Youth Crisis Center Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

192 Safe Haven Dr
Clarksburg, WV 26301
Phone (304) 622-1907

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1255081675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 SAFE HAVEN DR",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263019103",
            "telephone_number": "304-622-1907",
            "fax_number": "304-623-9346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 PRESSLEY RIDGE RD",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263017024",
            "telephone_number": "304-709-7020",
            "fax_number": "681-399-9115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS YOUTH CRISIS CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS YOUTH CRISIS CENTER, INC.",
        "enumeration_date": "2022-03-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "MAYER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CQI SPECIALIST",
        "authorized_official_telephone_number": "304-622-1907",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA, LSW"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diagnostic at Laurel Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.