| Autism Management Group | |
|
4552 Route 152 Lavalette WV 25535-9609 | |
| (304) 521-4252 | |
| Not Available |
| Full Name | Autism Management Group |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4552 Route 152, Lavalette, West Virginia |
| Authorized Official Name and Position | Tyrone Duncan Phillips (OWNER) |
| Authorized Official Contact | 3046174851 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Autism Management Group 4552 Route 152 Lavalette WV 25535-9609 Ph: (304) 521-4252 | Autism Management Group 4552 Route 152 Lavalette WV 25535-9609 Ph: (304) 521-4252 |
| NPI Number | 1912280405 |
|---|---|
| Provider Enumeration Date | 09/21/2011 |
| Last Update Date | 09/21/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912280405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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