Provider Demographics
NPI:1306486543
Name:OFF THE RAILS COUNSELING, LLC
Entity type:Organization
Organization Name:OFF THE RAILS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:TEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-377-1194
Mailing Address - Street 1:33 KRISTEN ST
Mailing Address - Street 2:
Mailing Address - City:SANDYVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25275-9349
Mailing Address - Country:US
Mailing Address - Phone:304-377-1194
Mailing Address - Fax:
Practice Address - Street 1:33 KRISTEN ST
Practice Address - Street 2:
Practice Address - City:SANDYVILLE
Practice Address - State:WV
Practice Address - Zip Code:25275-9349
Practice Address - Country:US
Practice Address - Phone:304-377-1194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1245549062Medicaid