Provider Demographics
NPI:1639384449
Name:FAMILY MATTERS PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:FAMILY MATTERS PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILSON STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:304-745-5065
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385-0490
Mailing Address - Country:US
Mailing Address - Phone:304-745-5065
Mailing Address - Fax:304-745-5067
Practice Address - Street 1:107 S. STREETCAR WAY
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385
Practice Address - Country:US
Practice Address - Phone:304-745-5065
Practice Address - Fax:304-745-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WV858103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty