Healthcare Provider Details

I. General information

NPI: 1962462572
Provider Name (Legal Business Name): JULIANNE M MCGINNIS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR SUITE B500
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR SUITE B500
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1500
  • Fax: 304-691-1510
Mailing address:
  • Phone: 304-691-1500
  • Fax: 304-691-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number575
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: