1982533543 NPI number — CARLESS JAMES ALAN PHILLIPS BA PSYCHOLOGY

Table of content: CARLESS JAMES ALAN PHILLIPS BA PSYCHOLOGY (NPI 1982533543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982533543 NPI number — CARLESS JAMES ALAN PHILLIPS BA PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
CARLESS
Provider Middle Name:
JAMES ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA PSYCHOLOGY
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:
1982533543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 COLONY DR
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:
25314-1790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
681-385-1124
Provider Business Mailing Address Fax Number:
304-727-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7004 KANAWHA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25177-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-7851
Provider Business Practice Location Address Fax Number:
304-722-0189
Provider Enumeration Date:
05/18/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , 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)





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