| Devaraj Behavioral Healthcare Pllc | |
|
1109 Jefferson Rd Ste C South Charleston WV 25309-8815 | |
| (877) 338-2725 | |
| (304) 715-3537 |
| Full Name | Devaraj Behavioral Healthcare Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1109 Jefferson Rd Ste C, South Charleston, West Virginia |
| Authorized Official Name and Position | Jacob M Bounds (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8773382725 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Devaraj Behavioral Healthcare Pllc 1109 Jefferson Rd Ste C South Charleston WV 25309-8815 Ph: (877) 338-2725 | Devaraj Behavioral Healthcare Pllc 1109 Jefferson Rd Ste C South Charleston WV 25309-8815 Ph: (877) 338-2725 |
| NPI Number | 1093362840 |
|---|---|
| Provider Enumeration Date | 08/26/2019 |
| Last Update Date | 01/05/2022 |
| Certification Date | 01/05/2022 |
| Medicare PECOS PAC ID | 9234565649 |
|---|---|
| Medicare Enrollment ID | O20200204000161 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093362840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Pamela Neal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548225881 PECOS PAC ID: 1052338530 Enrollment ID: I20051025000496 |
| Provider Name | Kiran Shashi Devaraj |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003878984 PECOS PAC ID: 6204857105 Enrollment ID: I20051207000524 |
| Provider Name | Jacob Matthew Bounds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154921799 PECOS PAC ID: 9032523592 Enrollment ID: I20230803000692 |
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