Provider Demographics
NPI:1750155156
Name:MCAULAY, JOHN HENRY III (PSYD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:MCAULAY
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 16TH STREET RD STE 12
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-5247
Mailing Address - Country:US
Mailing Address - Phone:681-404-6869
Mailing Address - Fax:
Practice Address - Street 1:3135 16TH STREET RD STE 12
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5247
Practice Address - Country:US
Practice Address - Phone:681-404-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1342103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist