Provider Demographics
NPI:1437542347
Name:PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UTILIZATION MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODPASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-525-7851
Mailing Address - Street 1:3375 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2837
Mailing Address - Country:US
Mailing Address - Phone:304-525-7851
Mailing Address - Fax:304-525-1073
Practice Address - Street 1:3375 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2837
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:304-525-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory