Provider Demographics
NPI:1437361466
Name:PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:YEARGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-255-0900
Mailing Address - Street 1:129 MAIN ST STE 608
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4670
Mailing Address - Country:US
Mailing Address - Phone:304-255-0900
Mailing Address - Fax:304-255-0900
Practice Address - Street 1:129 MAIN ST STE 608
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4670
Practice Address - Country:US
Practice Address - Phone:304-255-0900
Practice Address - Fax:304-255-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV166103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0165176000Medicaid
WVCP00641Medicare ID - Type UnspecifiedPSYCHOLOGY