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Certified Provider Details:
| PROVIDER NUMBER: | 490102 |
| AGENCY NAME: | Youth Health Services, Inc |
| CONTACT NAME: | Susie Mullens |
| ADDRESS: | 971 Harrison Avenue |
| CITY: | Elkins |
| STATE: | WV |
| ZIP: | 26241 |
| PHONE: | (304) 636-9450 |
| WEB SITE: | www.youth-health.org |
| EMAIL ADDRESS: | yhs@youth-health.org |
| BSW/MSW NAME: | Peggy Johnson |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |