1134131329 NPI number — MR. MICHAEL A KODRICH LPC

Table of content: MR. MICHAEL A KODRICH LPC (NPI 1134131329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134131329 NPI number — MR. MICHAEL A KODRICH LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KODRICH
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134131329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 EMERSON AVE
Provider Second Line Business Mailing Address:
SUITE 2-B
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26104-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-420-0940
Provider Business Mailing Address Fax Number:
304-865-2214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 EMERSON AVE
Provider Second Line Business Practice Location Address:
SUITE 2-B
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26104-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-420-0940
Provider Business Practice Location Address Fax Number:
304-865-2214
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1197 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y288393 . This is a "HEALTH PLAN PIN NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 096167 . This is a "VALUE OPTIONS PIN NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 180073 . This is a "COMPSYCH PIN NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2031476 . This is a "CIGNA HEALTH CARE PIN NUM" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000000234570 . This is a "ANTHEM PIN NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7227387 . This is a "AETNA PROVIDER PIN NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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