Individual
JOHN BRUCE TODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1418A MACCORKLE AVE SW, CHARLESTON, WV 25303
(304) 348-1288
(304) 348-1262
Mailing address
PO BOX 4009, CHARLESTON, WV 25364-4009
(304) 348-1288
(304) 348-1262
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
710
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9205058000
—
WV
Enumeration date
07/24/2006
Last updated
07/08/2007
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