Provider Demographics
NPI:1235137753
Name:PSYCHOTHERAPY PARTNERS PLLC
Entity type:Organization
Organization Name:PSYCHOTHERAPY PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-422-6304
Mailing Address - Street 1:1105 9TH ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-2105
Mailing Address - Country:US
Mailing Address - Phone:304-422-6304
Mailing Address - Fax:304-485-4466
Practice Address - Street 1:1105 9TH ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2105
Practice Address - Country:US
Practice Address - Phone:304-422-6304
Practice Address - Fax:304-485-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2365355Medicaid
WV9328407Medicare ID - Type Unspecified