Corey Lee Church
Individual provider Active NPI Behavior Technician · Parkersburg, WV
NPI 1467299404 · NPPES record last updated Jul 9, 2024
Key facts
- NPI
- 1467299404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 425 Juliana St
Parkersburg, WV 26101-5352 - Phone
- (304) 893-9777
- NPI assigned
- Jul 9, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clean and Clear Advantage | Current |
Accepting new patients | |
| Clean & Clear Advantage, LLC | Current |
Accepting new patients |
Locations
425 Juliana St
Parkersburg, WV 26101
Phone (304) 689-4334
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
425 Juliana St
Parkersburg, WV 26101-5352
Mailing address
425 Juliana St
Parkersburg, WV 26101-5352
Phone (304) 893-9777
Other providers in Parkersburg, WV
- Vonnie Mae Chipps
- Mary E Christian
- Mathew Bryan Christman
- Catherine A Church
- Chasidy Church
- Faye Annette Church
- Amanda Ciccone
- Joseph Christopher Cihlar
- Mark James Cinalli
- Emily Cinnamon
All providers in Parkersburg, WV · Behavior Technician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.