Basic Information
| Provider Information | |||||||||
| NPI: | 1982056404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APPALACHIAN PSYCHIATRIC SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1128 | ||||||||
| Address2: | |||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258021128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042524433 | ||||||||
| FaxNumber: | 3042521703 | ||||||||
| Practice Location | |||||||||
| Address1: | 1014 JOHNSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258014940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042524433 | ||||||||
| FaxNumber: | 3042521703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | FAHEEM | ||||||||
| AuthorizedOfficialFirstName: | AHMED | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3042524433 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2322-8649 | WV | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC0700X | 2322-8649 | WV | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 363A00000X | 2322-8649 | WV | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 2084P0800X | 2322-8649 | WV | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.