Provider Demographics
NPI:1003368671
Name:NORTH ALABAMA FAMILY PSYCHIATRY & COUNSELING
Entity Type:Organization
Organization Name:NORTH ALABAMA FAMILY PSYCHIATRY & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PETTWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-724-8880
Mailing Address - Street 1:9238 MADISON BLVD
Mailing Address - Street 2:SUITE 750
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9100
Mailing Address - Country:US
Mailing Address - Phone:256-727-8880
Mailing Address - Fax:888-951-7515
Practice Address - Street 1:9238 MADISON BLVD
Practice Address - Street 2:SUITE 750
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9100
Practice Address - Country:US
Practice Address - Phone:256-727-8880
Practice Address - Fax:888-951-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health