Healthcare Provider Details

I. General information

NPI: 1144433459
Provider Name (Legal Business Name): PSYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 6TH AVE STE 2
SOUTH CHARLESTON WV
25303-1265
US

IV. Provider business mailing address

312 6TH AVE STE 2
SOUTH CHARLESTON WV
25303-1265
US

V. Phone/Fax

Practice location:
  • Phone: 304-768-6170
  • Fax: 304-768-2099
Mailing address:
  • Phone: 304-768-6170
  • Fax: 304-768-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL BRUCE THISTLETHWAITE
Title or Position: CEO
Credential: MD
Phone: 304-768-6170