Healthcare Provider Details

I. General information

NPI: 1710352232
Provider Name (Legal Business Name): STANLEY PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY SUITE 412
WEIRTON WV
26062-5053
US

IV. Provider business mailing address

651 COLLIERS WAY SUITE 412
WEIRTON WV
26062-5053
US

V. Phone/Fax

Practice location:
  • Phone: 304-559-3821
  • Fax: 304-723-3426
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. PERRY GLENN STANLEY
Title or Position: OWNER
Credential:
Phone: 304-559-3821