Provider Demographics
NPI:1457767808
Name:STAFFORD, BETH (MS)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-0102
Mailing Address - Country:US
Mailing Address - Phone:304-622-5323
Mailing Address - Fax:304-622-5324
Practice Address - Street 1:321 W MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-0102
Practice Address - Country:US
Practice Address - Phone:304-622-5323
Practice Address - Fax:304-622-5324
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1090103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist