Provider Demographics
NPI:1326154634
Name:PSYCHOLOGICAL RESOURCES, INC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL RESOURCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CAPAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-599-1914
Mailing Address - Street 1:3606 COLLINS FERRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2363
Mailing Address - Country:US
Mailing Address - Phone:304-599-1914
Mailing Address - Fax:304-599-1955
Practice Address - Street 1:3606 COLLINS FERRY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2363
Practice Address - Country:US
Practice Address - Phone:304-599-1914
Practice Address - Fax:304-599-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV112103T00000X
WV507103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000571402OtherBCBS
WV3810009613Medicaid
WV9241351Medicare PIN