Basic Information
| Provider Information | |||||||||
| NPI: | 1780118851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERKINS | ||||||||
| FirstName: | KELCEY | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2585 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257031642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046971396 | ||||||||
| FaxNumber: | 3046972086 | ||||||||
| Practice Location | |||||||||
| Address1: | 1347 HILLVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255411513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047431407 | ||||||||
| FaxNumber: | 3047434516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2017 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | Q56841 | 01 | MEDICARE FFS | OTHER | 7100458750 | 05 | KY | MEDICAID | 0222658 | 05 | OH | MEDICAID | 1780118851 | 05 | WV | MEDICAID |