Basic Information
| Provider Information | |||||||||
| NPI: | 1871507038 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE PISGAH INSTITUTE FOR PSYCHOTHERAPY & EDUCATION, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 ZILLICOA ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288011079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282549494 | ||||||||
| FaxNumber: | 8282500890 | ||||||||
| Practice Location | |||||||||
| Address1: | 158 ZILLICOA ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288011079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282549494 | ||||||||
| FaxNumber: | 8282500890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 01/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | BARLEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8282549494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 0143 | NC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 0242K | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 6005476 | 05 | NC | MEDICAID |