Provider Demographics
NPI:1639426729
Name:BEHAVIORAL PEDIATRIC INSTITUTE OF ALABAMA
Entity Type:Organization
Organization Name:BEHAVIORAL PEDIATRIC INSTITUTE OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:BETHKE
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-414-6686
Mailing Address - Street 1:4 OFFICE PARK CIR STE 215A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2533
Mailing Address - Country:US
Mailing Address - Phone:205-414-6686
Mailing Address - Fax:
Practice Address - Street 1:4 OFFICE PARK CIR STE 215A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2533
Practice Address - Country:US
Practice Address - Phone:205-414-6686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11211750103K00000X
AL1106821103K00000X
AL1404103TC2200X
AL1715103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty