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General NPI Number Information
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NPI Number | 1457898298
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Entity Type | Individual
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Provider Name | MICHAEL RUNNER LPC
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Gender | Male
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 07/04/2023
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Provider Practice Location Address
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Address Line | 2413 E PIKE ST STE 125
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City | CLARKSBURG
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State | WV
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Zip | 26301-9117
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Country | US
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Telephone | 304-202-7001
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Fax | 808-640-3628
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Provider Business Mailing Address
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Address Line | 229 JOHNSON AVE
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1608
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Country | US
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Telephone | 304-838-1222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2053
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License Number State | WV
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