| Healing Grove Psychological Services, Llc | |
|
112 Shady Tree Ln Fairmont WV 26554-8394 | |
| (681) 404-0129 | |
| Not Available |
| Full Name | Healing Grove Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 112 Shady Tree Ln, Fairmont, West Virginia |
| Authorized Official Name and Position | Matthew Craig Kellar (FOUNDER/PSYCHOLOGIST) |
| Authorized Official Contact | 6814040129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Grove Psychological Services, Llc Po Box 113 Kingmont WV 26578-0113 Ph: (681) 404-0129 | Healing Grove Psychological Services, Llc 112 Shady Tree Ln Fairmont WV 26554-8394 Ph: (681) 404-0129 |
| NPI Number | 1780399725 |
|---|---|
| Provider Enumeration Date | 01/13/2023 |
| Last Update Date | 02/24/2023 |
| Certification Date | 02/24/2023 |
| Medicare PECOS PAC ID | 2668995283 |
|---|---|
| Medicare Enrollment ID | O20250325000724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780399725 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Matthew Kellar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285058453 PECOS PAC ID: 3971736919 Enrollment ID: I20140429000746 |
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