Provider Demographics
NPI:1487354866
Name:RUNNER COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:RUNNER COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-202-7001
Mailing Address - Street 1:229 JOHNSON AVE # A
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1608
Mailing Address - Country:US
Mailing Address - Phone:304-838-1122
Mailing Address - Fax:808-640-3628
Practice Address - Street 1:2413 E PIKE ST STE 125
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9117
Practice Address - Country:US
Practice Address - Phone:304-202-7001
Practice Address - Fax:808-640-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty