Basic Information
| Provider Information | |||||||||
| NPI: | 1831539360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KCL PSYCHOLOGICAL SOLUTIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 WHITESPORT CIR SW | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565339393 | ||||||||
| FaxNumber: | 2565339690 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 WHITESPORT CIR SW | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565339393 | ||||||||
| FaxNumber: | 2565339690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2013 | ||||||||
| LastUpdateDate: | 06/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEWALLEN | ||||||||
| AuthorizedOfficialFirstName: | KATIE | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2565339393 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1662 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.