Organization
AUTISM MANAGEMENT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYRONE DUNCAN PHILLIPS MS (OWNER)
(304) 617-4851
Entity
Organization
Contact information
Practice address
4552 ROUTE 152, LAVALETTE, WV 25535-9609
(304) 521-4252
Mailing address
4552 ROUTE 152, LAVALETTE, WV 25535-9609
(304) 521-4252
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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