1265782395 NPI number — DIVERSIFIED ASSESSMENT & THERAPY SERVICES

Table of content: TIERNEY MARIE BROWN BA (NPI 1740628890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265782395 NPI number — DIVERSIFIED ASSESSMENT & THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVERSIFIED ASSESSMENT & THERAPY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1265782395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 CHESTNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENOVA
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25530-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-453-2800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENOVA
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25530-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-453-2800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFITH
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
KISER
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
304-453-2800

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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)





Copyright © 2007-2026 www.npivalidator.com