Healthcare Provider Details

I. General information

NPI: 1811711542
Provider Name (Legal Business Name): ALLYSON BELLOMY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 US ROUTE 60 E
BARBOURSVILLE WV
25504-1609
US

IV. Provider business mailing address

3450 US ROUTE 60 E
BARBOURSVILLE WV
25504-1609
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-0036
  • Fax:
Mailing address:
  • Phone: 304-733-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number938
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: