=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326009580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTERN PSYCHOLOGICAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 278 N HIGH ST SUITE 1
-----------------------------------------------------
City | ROMNEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26757-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-822-3429
-----------------------------------------------------
Fax | 304-822-7225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 278 N HIGH ST P.O. BOX 1830
-----------------------------------------------------
City | ROMNEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26757-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-822-3429
-----------------------------------------------------
Fax | 304-822-7225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PSYCHOLOGIST
-----------------------------------------------------
Name | MRS. SHERI ELLEN COLEMAN
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 304-822-3429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 713
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------