Provider Demographics
NPI:1518653443
Name:WESTALL, BRODY RANDALL
Entity Type:Individual
Prefix:
First Name:BRODY
Middle Name:RANDALL
Last Name:WESTALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 COUNTY RD 775
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055
Mailing Address - Country:US
Mailing Address - Phone:770-856-0042
Mailing Address - Fax:
Practice Address - Street 1:475 PROVIDENCE MAIN ST NW STE 201
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4828
Practice Address - Country:US
Practice Address - Phone:256-489-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty