Provider Demographics
NPI:1497811798
Name:AMICK MCMULLAN, ANGELYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELYNNE
Middle Name:
Last Name:AMICK MCMULLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANGELYNNE
Other - Middle Name:ELIZABETH
Other - Last Name:MCMULLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:300 VESTAVIA OFFICE PARK
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3753
Mailing Address - Country:US
Mailing Address - Phone:205-822-7348
Mailing Address - Fax:205-822-7297
Practice Address - Street 1:300 VESTAVIA OFFICE PARK
Practice Address - Street 2:SUITE 3200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-3753
Practice Address - Country:US
Practice Address - Phone:205-822-7348
Practice Address - Fax:205-822-7297
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL603103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral