Provider Demographics
NPI:1497906663
Name:THE CENTER FOR PEDIATRIC NEUROPSYCHOLOGY & BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:THE CENTER FOR PEDIATRIC NEUROPSYCHOLOGY & BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LINZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-412-1637
Mailing Address - Street 1:PO BOX 2333
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25724-2333
Mailing Address - Country:US
Mailing Address - Phone:304-412-1637
Mailing Address - Fax:
Practice Address - Street 1:910 4TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1437
Practice Address - Country:US
Practice Address - Phone:304-412-1637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV550261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0163829000Medicaid