Basic Information
| Provider Information | |||||||||
| NPI: | 1285019927 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHIATRY 280 COUNSELING SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2803 GREYSTONE COMMERCIAL BLVD STE 12 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352429603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059681227 | ||||||||
| FaxNumber: | 2059681229 | ||||||||
| Practice Location | |||||||||
| Address1: | 2803 GREYSTONE COMMERCIAL BLVD STE 12 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352429603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059681227 | ||||||||
| FaxNumber: | 2059681229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2015 | ||||||||
| LastUpdateDate: | 03/15/2018 | ||||||||
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| AuthorizedOfficialLastName: | GOULD-HARTLINE | ||||||||
| AuthorizedOfficialFirstName: | LANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2059681227 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | 1048511 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.