NPIMap

Organization Active NPI

Devaraj Behavioral Healthcare PLLC

  • Psychiatry Physician
  • Charleston, WV
National Provider Identifier
1093362840
Registry record updated Dec 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
DEVARAJ BEHAVIORAL HEALTHCARE PLLC
Practice address
412 Tennessee Ave
Charleston, WV 25302-2338
Phone
(877) 338-2725
Fax
(304) 715-3537
NPI assigned
Aug 26, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jacob M Bounds, LGSWNPI 1154921799
Title
Clinical Director
Phone
(877) 338-2725

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

412 Tennessee Ave
Charleston, WV 25302-2338

Mailing address

412 Tennessee Ave
Charleston, WV 25302-2338
Phone (877) 338-2725

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200204000161 WV Part B Supplier - Clinic/Group Practice 9234565649 Receives reassigned benefits from 6 practitioners
Practice locations: Charleston, WV

National Provider Directory

National Provider Directory
Tax ID family
Devaraj Behavioral Healthcare PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

412 Tennessee Ave
Charleston, WV 25302
Phone (877) 338-2725

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765670400000",
    "number": "1093362840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 TENNESSEE AVE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253022338",
            "telephone_number": "877-338-2725",
            "fax_number": "304-715-3537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 TENNESSEE AVE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253022338",
            "telephone_number": "877-338-2725",
            "fax_number": "304-715-3537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVARAJ BEHAVIORAL HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-26",
        "last_updated": "2025-12-14",
        "certification_date": "2025-12-14",
        "status": "A",
        "authorized_official_last_name": "BOUNDS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "877-338-2725",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LGSW"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.