Provider Demographics
NPI:1225672058
Name:CSP PSYCHIATRY LLC
Entity Type:Organization
Organization Name:CSP PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER /CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPB
Authorized Official - Phone:205-968-1227
Mailing Address - Street 1:4505 PINE TREE CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2380
Mailing Address - Country:US
Mailing Address - Phone:205-453-4325
Mailing Address - Fax:
Practice Address - Street 1:4505 PINE TREE CIR STE 201
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2380
Practice Address - Country:US
Practice Address - Phone:205-453-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL149766Medicaid
AL150612Medicaid
AL150204Medicaid
MS09320028Medicaid
AL149645Medicaid