Healthcare Provider Details

I. General information

NPI: 1427824630
Provider Name (Legal Business Name): ADAM HANSELL PHD, LPC, MA, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 CHEAT RD
MORGANTOWN WV
26508-5631
US

IV. Provider business mailing address

933 CHEAT RD
MORGANTOWN WV
26508-5631
US

V. Phone/Fax

Practice location:
  • Phone: 304-554-2292
  • Fax:
Mailing address:
  • Phone: 304-554-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2916
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number1134
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: