Provider Demographics
NPI:1326009580
Name:EASTERN PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:EASTERN PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:EASTERN PSYCHOLOGICAL SERVICES OF WEST VIRGINIA, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-822-3429
Mailing Address - Street 1:278 N HIGH ST
Mailing Address - Street 2:P.O. BOX 1830
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1415
Mailing Address - Country:US
Mailing Address - Phone:304-822-3429
Mailing Address - Fax:304-822-7225
Practice Address - Street 1:278 N HIGH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1415
Practice Address - Country:US
Practice Address - Phone:304-822-3429
Practice Address - Fax:304-822-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0000102000Medicaid
WV0201722000Medicaid
WVCO4116121Medicare ID - Type UnspecifiedSHERI COLEMAN'S MEDICARE
WV0201722000Medicaid