| Mountain State Aba | |
|
1010 Winchester Ave Martinsburg WV 25401-1683 | |
| (304) 290-4262 | |
| (304) 212-0627 |
| Full Name | Mountain State Aba |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1010 Winchester Ave, Martinsburg, West Virginia |
| Authorized Official Name and Position | Ezra Hall (OWNER) |
| Authorized Official Contact | 3042904262 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain State Aba Po Box 442 Shepherdstown WV 25443-0442 Ph: (304) 290-4262 | Mountain State Aba 1010 Winchester Ave Martinsburg WV 25401-1683 Ph: (304) 290-4262 |
| NPI Number | 1093250060 |
|---|---|
| Provider Enumeration Date | 12/30/2016 |
| Last Update Date | 01/04/2022 |
| Certification Date | 01/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093250060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-14-16309 (West Virginia) | Primary |
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