Healthcare Provider Details

I. General information

NPI: 1184271181
Provider Name (Legal Business Name): AMY INGRAM SAULS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY INGRAM SAULS

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BROWN AVE
WESTON WV
26452-2177
US

IV. Provider business mailing address

5 BROWN AVE
WESTON WV
26452-2177
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-3923
  • Fax: 304-269-9733
Mailing address:
  • Phone: 304-269-3923
  • Fax: 304-269-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1236
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: