NPIMap

Organization Active NPI

Professional Counseling Associates, Inc.

  • Psychologist
  • Williamson, WV
National Provider Identifier
1720143555
Registry record updated Aug 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
403 Issued in WV
Legal business name
PROFESSIONAL COUNSELING ASSOCIATES, INC.
Practice address
41 W 5TH Ave
Williamson, WV 25661-3201
Phone
(304) 235-3390
Fax
(304) 235-3391
NPI assigned
Dec 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2015

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

Authorized official

Name
Dr. Susan Carol Baisden, PHDNPI 1558361527
Title
Owner Therapist
Phone
(304) 235-3390

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: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 538 WV
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 403 WV Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X CP00452669 WV

Addresses

Primary practice location

41 W 5TH Ave
Williamson, WV 25661-3201

Mailing address

41 W 5TH Ave
Williamson, WV 25661-3201
Phone (304) 235-3390

Other identifiers 3

IdentifierTypeStateIssuer
3810007784MedicaidWV
062399OtherVALUE OPTIONS
0163475000MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000418 WV Part B Supplier - Clinic/Group Practice 4284528977 Receives reassigned benefits from 1 practitioner
Practice locations: Williamson, WV

National Provider Directory

National Provider Directory

Locations

105 W 4th Ave
Williamson, WV 25661
Phone (304) 235-3390

41 W 5th Ave
Williamson, WV 25661
Phone (304) 235-3390

Practitioners & affiliated clinicians

Practitioners 5

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": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438560000000",
    "number": "1720143555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 W 5TH AVE",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613201",
            "telephone_number": "304-235-3390",
            "fax_number": "304-235-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 W 5TH AVE",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613201",
            "telephone_number": "304-235-3390",
            "fax_number": "304-235-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL COUNSELING ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2015-08-03",
        "status": "A",
        "authorized_official_last_name": "BAISDEN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "OWNER THERAPIST",
        "authorized_official_telephone_number": "304-235-3390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "WV",
            "license": "538",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "WV",
            "license": "403",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "CP00452669",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810007784",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "062399",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0163475000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamson, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; 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.