Provider Demographics
NPI:1205904836
Name:BEACON PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:BEACON PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-945-1550
Mailing Address - Street 1:600 BEACON PARKWAY WEST
Mailing Address - Street 2:SUITE 850
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210
Mailing Address - Country:US
Mailing Address - Phone:205-945-1550
Mailing Address - Fax:205-945-1260
Practice Address - Street 1:600 BEACON PKWY W
Practice Address - Street 2:SUITE 850
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3120
Practice Address - Country:US
Practice Address - Phone:205-945-1550
Practice Address - Fax:205-945-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR76017Medicare UPIN
ALR76015Medicare UPIN