Healthcare Provider Details

I. General information

NPI: 1689185704
Provider Name (Legal Business Name): BANYAN TREE COUNSELING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 MAPLE DR
MORGANTOWN WV
26505-0387
US

IV. Provider business mailing address

1063 MAPLE DR STE 1
MORGANTOWN WV
26505-0387
US

V. Phone/Fax

Practice location:
  • Phone: 304-626-5824
  • Fax:
Mailing address:
  • Phone: 304-626-5824
  • Fax: 304-599-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1807
License Number StateWV

VIII. Authorized Official

Name: DR. NANCY S TAYLOR
Title or Position: OWNER
Credential: PHD, LPC, RN, NCC
Phone: 304-626-5824