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General NPI Number Information
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NPI Number | 1437361466
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 129 MAIN ST STE 608
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City | BECKLEY
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State | WV
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Zip | 25801-4670
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Country | US
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Telephone | 304-255-0900
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Fax | 304-255-0900
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Provider Business Mailing Address
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Address Line | 129 MAIN ST STE 608
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City | BECKLEY
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State | WV
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Zip | 25801-4670
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Country | US
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Telephone | 304-255-0900
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Fax | 304-255-0900
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES B. YEARGAN
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Credential | PH.D.
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Telephone | 304-255-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 166
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License Number State | WV
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