1306063268 NPI number — SAAR PSYCHOLOGICAL GROUP PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306063268 NPI number — SAAR PSYCHOLOGICAL GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAAR PSYCHOLOGICAL GROUP PLLC
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:
1306063268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1461 BROOKSTONE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25314-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-343-4878
Provider Business Mailing Address Fax Number:
304-343-2376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SOUTH CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25303-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-744-8866
Provider Business Practice Location Address Fax Number:
304-513-1222
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAAR
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
304-744-8866

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  654 , 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: 001714954 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810008372 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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