Healthcare Provider Details

I. General information

NPI: 1164559860
Provider Name (Legal Business Name): TAMMY MORGAN HAMNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 W MAIN ST HARRON SQUARE, SUITE 203
BRIDGEPORT WV
26330-1650
US

IV. Provider business mailing address

917 W MAIN ST HARRON SQUARE, SUITE 203
BRIDGEPORT WV
26330-1650
US

V. Phone/Fax

Practice location:
  • Phone: 304-842-7007
  • Fax: 304-842-7099
Mailing address:
  • Phone: 304-842-7007
  • Fax: 304-842-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberWV #570
License Number StateWV

VIII. Authorized Official

Name: TAMMY MORGAN HAMNER
Title or Position: LICENSED PSYCHOLOGIST
Credential:
Phone: 304-842-7007