Provider Demographics
NPI:1215270467
Name:WYTHE WELLBEING, EMOTIONAL AND BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:WYTHE WELLBEING, EMOTIONAL AND BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:REY
Authorized Official - Last Name:IHRIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-546-8388
Mailing Address - Street 1:469 SHARITZ RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4671
Mailing Address - Country:US
Mailing Address - Phone:276-546-8388
Mailing Address - Fax:276-546-8733
Practice Address - Street 1:150 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2376
Practice Address - Country:US
Practice Address - Phone:276-546-8388
Practice Address - Fax:276-546-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0904005700261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598731853Medicaid