Provider Demographics
NPI:1073681755
Name:ALLEGHENY COUNSELING SERVICES
Entity Type:Organization
Organization Name:ALLEGHENY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-267-1663
Mailing Address - Street 1:PO BOX 2712
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402
Mailing Address - Country:US
Mailing Address - Phone:304-267-1663
Mailing Address - Fax:304-267-1663
Practice Address - Street 1:300 FOXCROFT AV
Practice Address - Street 2:STE 306
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-267-1663
Practice Address - Fax:304-267-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCP14701Medicare ID - Type Unspecified