Provider Demographics
NPI:1245392091
Name:CLINICAL AND FORENSIC PSYCHOLOGISTS, P.C.
Entity Type:Organization
Organization Name:CLINICAL AND FORENSIC PSYCHOLOGISTS, P.C.
Other - Org Name:KIRKLAND & KING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-269-1106
Mailing Address - Street 1:1520 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1520
Mailing Address - Country:US
Mailing Address - Phone:334-269-1106
Mailing Address - Fax:334-832-9557
Practice Address - Street 1:1520 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1520
Practice Address - Country:US
Practice Address - Phone:334-269-1106
Practice Address - Fax:334-832-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD617Medicare ID - Type Unspecified