MEDICARE: DWAYNE F MASTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	AP00940097	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP00940097	OTHER	WV	SOCIAL WORK

General Provider Information

NPI Number	:	1316100522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWAYNE F MASTERS

Provider Business Mailing Address
First Line	:	130 GEORGE ST # 6
Second Line	:	SUITE E-F
City	:	BECKLEY
State	:	WV
Zip	:	25801-2648
Country	:	US
Telephone Number	:	304-256-0200
Fax Number	:	304-256-0380

Provider Business Practice Location Address
First Line	:	130 GEORGE ST # 6
Second Line	:	SUITE E-F
City	:	BECKLEY
State	:	WV
Zip	:	25801-2648
Country	:	US
Telephone Number	:	304-256-0200
Fax Number	:	304-256-0380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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Directions to “ DWAYNE F MASTERS ” Practice Location

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