Provider Demographics
NPI:1356475412
Name:PSYCHOLOGICAL ASSESSMENT AND INTERVENTION SERVICES, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT AND INTERVENTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WV DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-992-6153
Mailing Address - Street 1:1 DUNBAR PLAZA
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064
Mailing Address - Country:US
Mailing Address - Phone:304-346-9586
Mailing Address - Fax:304-344-2169
Practice Address - Street 1:1 DUNBAR PLAZA
Practice Address - Street 2:SUITE 100-A
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064
Practice Address - Country:US
Practice Address - Phone:304-346-9586
Practice Address - Fax:304-344-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV566103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710371OtherMT STATE BCBS
WV0005412003Medicaid
WV0005412000Medicaid
WV490712OtherAETNA VALUE OPTIONS
WV0005412001Medicaid
WV0163911000Medicaid
WV70365OtherUMWA
WV0163911000Medicaid