Healthcare Provider Details

I. General information

NPI: 1548632425
Provider Name (Legal Business Name): CLAUDIA NEELY MA, MDIV, BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HIGH ST STE 716 WHOLE FAMILIES / WHOLE VETERANS, PLLC
MORGANTOWN WV
26505-5448
US

IV. Provider business mailing address

PO BOX 197
MORGANTOWN WV
26507-0197
US

V. Phone/Fax

Practice location:
  • Phone: 304-906-9087
  • Fax: 304-212-7379
Mailing address:
  • Phone: 304-906-9087
  • Fax: 304-212-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH002751
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-20152
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: