Provider Demographics
NPI:1487829966
Name:MENTAL HEALTH BOARD OF CHILTON AND SHELBY COUNTIES INC
Entity Type:Organization
Organization Name:MENTAL HEALTH BOARD OF CHILTON AND SHELBY COUNTIES INC
Other - Org Name:CHILTON-SHELBY MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-668-4308
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-0689
Mailing Address - Country:US
Mailing Address - Phone:205-755-8800
Mailing Address - Fax:205-755-8882
Practice Address - Street 1:110 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2332
Practice Address - Country:US
Practice Address - Phone:205-755-8800
Practice Address - Fax:205-755-8882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH BOARD OF CHILTON AND SHELBY COUNTIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-11686OtherBLUE CROSS/BLUE SHIELD ALL KIDS PLUS