Provider Demographics
NPI:1942295654
Name:BELL, THOMAS MELVIN (LICENS PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MELVIN
Last Name:BELL
Suffix:
Gender:M
Credentials:LICENS PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4672
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26504-4672
Mailing Address - Country:US
Mailing Address - Phone:304-626-5737
Mailing Address - Fax:
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:304-626-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710319OtherBCBS
WV164541000Medicaid
WV001710319OtherBCBS