| Laurel Ridge Psychological Associates | |
|
211 Hunter Park Laurel Ridge Psychological Associates Princeton WV 24740 | |
| (304) 487-6121 | |
| (304) 487-8741 |
| Full Name | Laurel Ridge Psychological Associates |
|---|---|
| Speciality | Psychologist |
| Location | 211 Hunter Park, Princeton, West Virginia |
| Authorized Official Name and Position | David T Ellis (PSYCHOLOGIST/PARTNER) |
| Authorized Official Contact | 3044876121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laurel Ridge Psychological Associates 211 Hunter Park Laurel Ridge Psychological Associates Princeton WV 24740 Ph: (304) 487-6121 | Laurel Ridge Psychological Associates 211 Hunter Park Laurel Ridge Psychological Associates Princeton WV 24740 Ph: (304) 487-6121 |
| NPI Number | 1790845816 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 03/20/2017 |
| Medicare PECOS PAC ID | 3375696578 |
|---|---|
| Medicare Enrollment ID | O20090805000810 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790845816 | NPI | - | NPPES |
| 3810006182 | Medicaid | WV | |
| 3810016706 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 988 (West Virginia) | Primary |
| Provider Name | David T Ellis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093043754 PECOS PAC ID: 2860521135 Enrollment ID: I20100525000407 |
| Provider Name | John Perry Bowyer |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1871875856 PECOS PAC ID: 8820300759 Enrollment ID: I20150707002440 |
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