Provider Demographics
NPI:1679931398
Name:MATTHEW REMICK PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:MATTHEW REMICK PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REMICK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:205-223-4353
Mailing Address - Street 1:15 OFFICE PARK CIR STE 140
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2562
Mailing Address - Country:US
Mailing Address - Phone:205-438-7711
Mailing Address - Fax:205-438-7711
Practice Address - Street 1:15 OFFICE PARK CIR STE 140
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2562
Practice Address - Country:US
Practice Address - Phone:205-438-7711
Practice Address - Fax:205-438-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL111524Medicaid
AL111524Medicaid