| 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 | Community/behavioral Health |
| 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 | This clinic does not participate in Medicare Program. |
| 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 | 1356980916 |
|---|---|
| Provider Enumeration Date | 12/31/2019 |
| Last Update Date | 01/05/2022 |
| Certification Date | 01/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356980916 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Devaraj Behavioral Healthcare Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1109 Jefferson Rd Ste C, South Charleston, WV 25309 Phone: 877-338-2725 Fax: 304-715-3537 | |
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