Provider Demographics
NPI:1922279983
Name:ALABAMA PSYCHOLOGICAL SERVICES CENTER
Entity Type:Organization
Organization Name:ALABAMA PSYCHOLOGICAL SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-533-9393
Mailing Address - Street 1:4800 WHITESPORT CIR SW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6428
Mailing Address - Country:US
Mailing Address - Phone:256-533-9393
Mailing Address - Fax:256-533-9690
Practice Address - Street 1:4800 WHITESPORT CIR SW
Practice Address - Street 2:SUITE 2
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6428
Practice Address - Country:US
Practice Address - Phone:256-533-9393
Practice Address - Fax:256-533-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YP2500X, 103T00000X, 1041C0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1027G02244Medicare PIN