Individual provider Active NPI

William Allen Brezinski, M.A.

  • Counseling Psychologist
  • Princeton, WV
National Provider Identifier
1609895440
Registry record updated Sep 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
282 Issued in WV
Practice address
211 Hunter Park
Laurel Ridge Psychological Associates
Princeton, WV 24740
Phone
(304) 487-6121
Fax
(304) 487-8741
NPI assigned
Jul 19, 2006
Last updated
Sep 18, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 282 WV Primary
School Psychologist 103TS0200X 22034 WV

Addresses

Primary practice location

211 Hunter Park
Laurel Ridge Psychological Associates
Princeton, WV 24740

Mailing address

211 Hunter Park
Laurel Ridge Psychological Associates
Princeton, WV 24740
Phone (304) 487-6121

Other identifiers 2

IdentifierTypeStateIssuer
0162860000MedicaidWV
007709064MedicaidVA

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)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
22034WVMDSchool Psychologist
282WVMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
New Hope Hearing Solutions, LLC PastSince Jul 25, 2021 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1609895440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 HUNTER PARK",
            "address_2": "LAUREL RIDGE PSYCHOLOGICAL ASSOCIATES",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "24740",
            "telephone_number": "304-487-6121",
            "fax_number": "304-487-8741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 HUNTER PARK",
            "address_2": "LAUREL RIDGE PSYCHOLOGICAL ASSOCIATES",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "24740",
            "telephone_number": "304-487-6121",
            "fax_number": "304-487-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREZINSKI",
        "first_name": "WILLIAM",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "WV",
            "license": "282",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "WV",
            "license": "22034",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0162860000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007709064",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; 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.