Healing Grove Psychological Services, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

HEALING GROVE PSYCHOLOGICAL SERVICES, LLC

Practice address

112 Shady Tree LN
Fairmont, WV 26554-8394

Phone

(681) 404-0129

NPI assigned

Jan 13, 2023

Last updated

Feb 24, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Craig Kellar, PSYDNPI 1285058453

Title

Founder/Psychologist

Phone

(681) 404-0129

Specialties & licenses 1

Addresses

Other names 1

• Kellar Psychological Services, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Craig Kellar, PSY.D.

  • Psychologist
  • Huntington, WV
  • NPI 1285058453
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1673568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1780399725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 113",
            "city": "KINGMONT",
            "state": "WV",
            "postal_code": "265780113",
            "telephone_number": "681-404-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 SHADY TREE LN",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265548394",
            "telephone_number": "681-404-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING GROVE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-13",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "KELLAR",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "FOUNDER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "681-404-0129",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kellar Psychological Services, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Kellar Psychological Services, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Willie Hayes
• Ian Hayhurst
• Karri Hayhurst, BSN, RN, NCSN
• Ryan Michael Hayhurst, PHARMD
• Kelly Jo Hazuka, NP-C
• Desiree Lynn Heater
• Heather McDonnell-Stalnaker, LPC, LLC
• Melyssa Ellen Hedrick
• Amanda Heflin
• David Michael Hefner, D.O.

• Psychologist in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Psychologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; 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.