Provider Demographics
NPI:1396630752
Name:SOUTH BRANCH PSYCHOLOGY GROUP, PLLC
Entity type:Organization
Organization Name:SOUTH BRANCH PSYCHOLOGY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-257-2485
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-0392
Mailing Address - Country:US
Mailing Address - Phone:304-257-2485
Mailing Address - Fax:
Practice Address - Street 1:15 GRANT ST UNIT 4
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1688
Practice Address - Country:US
Practice Address - Phone:304-257-2485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty