Healthcare Provider Details

I. General information

NPI: 1982056404
Provider Name (Legal Business Name): APPALACHIAN PSYCHIATRIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 JOHNSTOWN RD
BECKLEY WV
25801-4940
US

IV. Provider business mailing address

PO BOX 1128
BECKLEY WV
25802-1128
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-4433
  • Fax: 304-252-1703
Mailing address:
  • Phone: 304-252-4433
  • Fax: 304-252-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2322-8649
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2322-8649
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2322-8649
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2322-8649
License Number StateWV

VIII. Authorized Official

Name: AHMED D FAHEEM
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 304-252-4433