Provider Demographics
NPI:1083781785
Name:WEST ALABAMA MENTAL HEALTH BOARD
Entity Type:Organization
Organization Name:WEST ALABAMA MENTAL HEALTH BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:PARRIS
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:334-289-2410
Mailing Address - Street 1:1215 S WALNUT AVE
Mailing Address - Street 2:P.O. BOX 260
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3615
Mailing Address - Country:US
Mailing Address - Phone:334-289-2410
Mailing Address - Fax:334-289-2416
Practice Address - Street 1:1215 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3615
Practice Address - Country:US
Practice Address - Phone:334-289-2410
Practice Address - Fax:334-289-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3300000000Medicaid