Provider Demographics
NPI:1326539016
Name:DUMAS PSYCHOLOGY COLLECTIVE
Entity Type:Organization
Organization Name:DUMAS PSYCHOLOGY COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-242-1447
Mailing Address - Street 1:117 LEE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6037
Mailing Address - Country:US
Mailing Address - Phone:301-379-0121
Mailing Address - Fax:
Practice Address - Street 1:1207 S FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6638
Practice Address - Country:US
Practice Address - Phone:301-379-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWVTPID008558Medicaid