NPIMap

Individual provider Active NPI

Myra Marie Moore

  • Psychologist
  • Summersville, WV
National Provider Identifier
1154673184
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
22070 Issued in WV
Practice address
402 Church St Ste 2
Summersville, WV 26651-1495
Phone
(304) 256-4555
Fax
(304) 256-4715
NPI assigned
Oct 15, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 22070 WV
Psychologist 103T00000X 22070 WV Primary

Addresses

Primary practice location

402 Church St Ste 2
Summersville, WV 26651-1495

Mailing address

PO Box 211
Mount Nebo, WV 26679-0211
Phone (304) 719-9701

Other practice location 1

111 Fayette Ave
Fayetteville, WV 25840-1219
Phone (304) 574-1176

Other names 1

  • Myra Marie Beam Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Resilient Youth, PLLC Psychologist CurrentSince Jun 18, 2023 Accepting new patients
Raleigh County Schools Past Accepting new patients
Fayette County Board of Education Past Accepting new patients
Fayette County Board of Education Past Accepting new patients

Locations

402 Church St
Ste 2
Summersville, WV 26651
Phone (304) 256-4555

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1154673184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211",
            "city": "MOUNT NEBO",
            "state": "WV",
            "postal_code": "266790211",
            "telephone_number": "304-719-9701",
            "fax_number": "304-872-4453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 CHURCH ST STE 2",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266511495",
            "telephone_number": "304-256-4555",
            "fax_number": "304-256-4715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Fayette Ave",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "WV",
            "postal_code": "258401219",
            "country_code": "US",
            "telephone_number": "304-574-1176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MYRA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-15",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "WV",
            "license": "22070",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WV",
            "license": "22070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MYRA",
            "last_name": "BEAM",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Summersville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.