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NPI Code Detail

MEDICARE: TARYN EISENBREY

MEDICARE: TARYN EISENBREY
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
1390200000XStudent in an Organized Health Care Education/Training Program
2103TC0700XClinical Psychologist1124WV

General Provider Information

NPI Number : 1568750867
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARYN EISENBREY
Provider Business Mailing Address
First Line : 971 HARRISON AVE
Second Line :
City : ELKINS
State : WV
Zip : 26241-3608
Country : US
Telephone Number : 304-636-9450
Fax Number :
Provider Business Practice Location Address
First Line : 971 HARRISON AVE
Second Line :
City : ELKINS
State : WV
Zip : 26241-3608
Country : US
Telephone Number : 304-636-9450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2011
Last Update Date : 03/23/2016

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Directions to “ TARYN EISENBREY ” Practice Location

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