Healthcare Provider Details

I. General information

NPI: 1306486543
Provider Name (Legal Business Name): OFF THE RAILS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 KRISTEN ST
SANDYVILLE WV
25275-9349
US

IV. Provider business mailing address

33 KRISTEN ST
SANDYVILLE WV
25275-9349
US

V. Phone/Fax

Practice location:
  • Phone: 304-377-1194
  • Fax:
Mailing address:
  • Phone: 304-377-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: BOBBI JO TEASLEY
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 304-377-1194