Provider Demographics
NPI:1952483422
Name:WEST VIRGINIA UNIVERSITY
Entity Type:Organization
Organization Name:WEST VIRGINIA UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FREMOUW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-293-2001
Mailing Address - Street 1:53 CAMPUS DRIVE
Mailing Address - Street 2:PO BOX 6040
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-6040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 CAMPUS DRIVE
Practice Address - Street 2:LIFE SCIENCES BUILDING
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-6040
Practice Address - Country:US
Practice Address - Phone:304-293-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV151103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty