Healthcare Provider Details

I. General information

NPI: 1639384449
Provider Name (Legal Business Name): FAMILY MATTERS PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S. STREETCAR WAY
LOST CREEK WV
26385
US

IV. Provider business mailing address

PO BOX 490
LOST CREEK WV
26385-0490
US

V. Phone/Fax

Practice location:
  • Phone: 304-745-5065
  • Fax: 304-745-5067
Mailing address:
  • Phone: 304-745-5065
  • Fax: 304-745-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number858
License Number StateWV

VIII. Authorized Official

Name: DR. AMY G WILSON STRANGE
Title or Position: PSYCHOLOGIST
Credential: PH. D.
Phone: 304-745-5065