Provider Demographics
NPI:1386923480
Name:CHONG, JASON ALEXANDER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALEXANDER
Last Name:CHONG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-6840
Mailing Address - Country:US
Mailing Address - Phone:503-724-6161
Mailing Address - Fax:
Practice Address - Street 1:9000 COOMBS FARM DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508
Practice Address - Country:US
Practice Address - Phone:304-554-0504
Practice Address - Fax:304-554-0505
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1024103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026905Medicaid
WV3810026905Medicaid