Provider Demographics
NPI:1710012398
Name:MONTGOMERY AREA MENTAL HEALTH AUTHORITY INC
Entity Type:Organization
Organization Name:MONTGOMERY AREA MENTAL HEALTH AUTHORITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-279-7830
Mailing Address - Street 1:PO BOX 3223
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-0223
Mailing Address - Country:US
Mailing Address - Phone:334-279-7830
Mailing Address - Fax:334-277-8862
Practice Address - Street 1:2140 UPPER WETUMPKA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-1342
Practice Address - Country:US
Practice Address - Phone:334-279-7830
Practice Address - Fax:334-277-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
AL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51008123OtherBLUE CROSS BLUE SHIELD