NPIMap

Organization Active NPI

Phoenix Psychological & Counseling Assoc Inc

  • Counselor
  • Quiet Dell, WV
National Provider Identifier
1386631786
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
PHOENIX PSYCHOLOGICAL & COUNSELING ASSOC INC
Practice address
RT 20
Quiet Dell, WV 26408
Phone
(304) 622-6404
Fax
(304) 622-6404
NPI assigned
Sep 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Charles McClure GreenNPI 1245225952
Title
Owner
Phone
(304) 622-6404

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X WV Primary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X WV
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X WV

Addresses

Primary practice location

RT 20
Quiet Dell, WV 26408

Mailing address

4579 Buckhannon Pike Ste 101
Mount Clare, WV 26408-7176
Phone (304) 622-6404

Other identifiers 1

IdentifierTypeStateIssuer
001710319OtherWVBCBS

National Provider Directory

National Provider Directory

Locations

4579 Buckhannon Pike
#101
Mount Clare, WV 26408
Phone (304) 622-6404

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386631786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4579 BUCKHANNON PIKE STE 101",
            "city": "MOUNT CLARE",
            "state": "WV",
            "postal_code": "264087176",
            "telephone_number": "304-622-6404",
            "fax_number": "304-622-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RT 20",
            "city": "QUIET DELL",
            "state": "WV",
            "postal_code": "26408",
            "telephone_number": "304-622-6404",
            "fax_number": "304-622-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PSYCHOLOGICAL & COUNSELING ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "MCCLURE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-622-6404",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "WV",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "WV",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "001710319",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quiet Dell, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.