Provider Demographics
NPI:1487829917
Name:MONTGOMERY AREA MENTAL HEALTH AUTHORITY INC
Entity Type:Organization
Organization Name:MONTGOMERY AREA MENTAL HEALTH AUTHORITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TOMMY
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-279-7830
Mailing Address - Street 1:101 COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-2707
Mailing Address - Country:US
Mailing Address - Phone:334-279-7830
Mailing Address - Fax:334-279-3714
Practice Address - Street 1:101 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-2707
Practice Address - Country:US
Practice Address - Phone:334-279-7830
Practice Address - Fax:334-279-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51008123OtherBCBS
AL515-11697OtherALKIDS PLUS