Provider Demographics
NPI:1851740971
Name:KARL KIRKLAND, PH.D, PC
Entity Type:Organization
Organization Name:KARL KIRKLAND, PH.D, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-215-4466
Mailing Address - Street 1:8650 MINNIE BROWN RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7803
Mailing Address - Country:US
Mailing Address - Phone:334-215-4466
Mailing Address - Fax:334-215-4469
Practice Address - Street 1:8650 MINNIE BROWN RD
Practice Address - Street 2:SUITE 116
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7803
Practice Address - Country:US
Practice Address - Phone:334-215-4466
Practice Address - Fax:334-215-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL166424Medicaid
AL890007150Medicaid
AL166424Medicaid