Provider Demographics
NPI:1841221272
Name:CLINICAL PSYCHOLOGISTS, P.C.
Entity Type:Organization
Organization Name:CLINICAL PSYCHOLOGISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-821-3350
Mailing Address - Street 1:248 E GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4818
Mailing Address - Country:US
Mailing Address - Phone:334-821-3350
Mailing Address - Fax:334-821-3252
Practice Address - Street 1:248 E GLENN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4818
Practice Address - Country:US
Practice Address - Phone:334-821-3350
Practice Address - Fax:334-821-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL578103TC0700X
AL607103TC0700X
AL181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51509821OtherBCBS
AL70628OtherBCBS
AL70627OtherBCBS
AL72343OtherBCBS
AL51003710OtherBCBS
AL73346OtherBCBS
AL51533748OtherBCBS
AL51533703OtherBCBS
AL72183OtherBCBS
AL51003710OtherBCBS
AL70627OtherBCBS
ALR63280Medicare UPIN
ALR63289Medicare UPIN
AL72183OtherBCBS