Provider Demographics
NPI:1457357261
Name:PARK VALLEY BEHAVIORAL HEALTH CARE, PLLC
Entity Type:Organization
Organization Name:PARK VALLEY BEHAVIORAL HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-218-2023
Mailing Address - Street 1:32 20TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3747
Mailing Address - Country:US
Mailing Address - Phone:304-218-2023
Mailing Address - Fax:304-218-2026
Practice Address - Street 1:32 20TH ST STE 500
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3747
Practice Address - Country:US
Practice Address - Phone:304-218-2023
Practice Address - Fax:304-218-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV169182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0204413000Medicaid
9328521Medicare ID - Type Unspecified