Basic Information
| Provider Information | |||||||||
| NPI: | 1922279983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALABAMA PSYCHOLOGICAL SERVICES CENTER | ||||||||
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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: | 03/18/2008 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | POPE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2565339393 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | AL | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YP2500X | AL | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103T00000X | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.