Provider Demographics
NPI:1912392838
Name:CHIRON PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:CHIRON PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-669-6408
Mailing Address - Street 1:1907 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8527
Mailing Address - Country:US
Mailing Address - Phone:304-669-6408
Mailing Address - Fax:
Practice Address - Street 1:1907 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8527
Practice Address - Country:US
Practice Address - Phone:304-669-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV756103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty