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General NPI Number Information
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NPI Number | 1184050304
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Entity Type | Organization
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Legal Business Name | PANHANDLE PSYCHOLOGICAL CENTER, P.L.L.C.
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 93 CRIMSON CIR SUITE 11
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City | MARTINSBURG
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State | WV
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Zip | 25403-6397
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Country | US
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Telephone | 304-886-5706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2567
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City | MARTINSBURG
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State | WV
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Zip | 25402-2567
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Country | US
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Telephone | 304-886-5706
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/COUNSELOR
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Name | MS. EMILY KRISTEN OSTERMAN
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Credential | M.S.
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Telephone | 304-886-5706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1895
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC4395
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1020
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License Number State | WV
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