Provider Demographics
NPI:1912913773
Name:SPAULDING PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SPAULDING PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-643-5399
Mailing Address - Street 1:143 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-7465
Mailing Address - Country:US
Mailing Address - Phone:304-643-5399
Mailing Address - Fax:304-643-5398
Practice Address - Street 1:216 W NORTH ST
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362-1047
Practice Address - Country:US
Practice Address - Phone:304-643-5399
Practice Address - Fax:304-643-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV017787261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000741Medicaid
WV001849704OtherBLUECROSSBLUESHIELD