Healthcare Provider Details

I. General information

NPI: 1114464203
Provider Name (Legal Business Name): STEVEN R AMTOWER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CENTER ST
KEYSER WV
26726-3520
US

IV. Provider business mailing address

130 CENTER ST
KEYSER WV
26726-3520
US

V. Phone/Fax

Practice location:
  • Phone: 304-788-1113
  • Fax:
Mailing address:
  • Phone: 304-788-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2393
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: