Healthcare Provider Details

I. General information

NPI: 1922041136
Provider Name (Legal Business Name): BEHAVIORAL HEALTH MANAGEMENT GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAIN ST SUITE 708 MULL CENTER
WHEELING WV
26003-2726
US

IV. Provider business mailing address

1025 MAIN ST SUITE 708 MULL CENTER
WHEELING WV
26003-2726
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-7232
  • Fax: 304-232-7245
Mailing address:
  • Phone: 304-232-7232
  • Fax: 304-232-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1697
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1683
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number313
License Number StateWV

VIII. Authorized Official

Name: DR. JOHN MCFADDEN
Title or Position: PRESIDENT
Credential: PSY. D.
Phone: 304-232-7232