Provider Demographics
NPI:1659548444
Name:WESTERN MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:WESTERN MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-788-7770
Mailing Address - Street 1:1701 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35218-1532
Mailing Address - Country:US
Mailing Address - Phone:205-788-7770
Mailing Address - Fax:205-788-7552
Practice Address - Street 1:1701 AVENUE D
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-1532
Practice Address - Country:US
Practice Address - Phone:205-788-7770
Practice Address - Fax:205-788-7552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000006Medicaid