Provider Demographics
NPI:1578818597
Name:BEN F. MCMATH, PH.D.
Entity Type:Organization
Organization Name:BEN F. MCMATH, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCMATH
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-310-4497
Mailing Address - Street 1:10980 MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:VANCE
Mailing Address - State:AL
Mailing Address - Zip Code:35490-2531
Mailing Address - Country:US
Mailing Address - Phone:205-310-4497
Mailing Address - Fax:
Practice Address - Street 1:2703 7TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1865
Practice Address - Country:US
Practice Address - Phone:205-310-4497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty