Provider Demographics
NPI:1275381618
Name:KALEIDOSCOPE: ADHD AND AUTISM ASSESSMENT AND COUNSELING LLC
Entity Type:Organization
Organization Name:KALEIDOSCOPE: ADHD AND AUTISM ASSESSMENT AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KELLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:205-789-0459
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-0553
Mailing Address - Country:US
Mailing Address - Phone:205-789-0459
Mailing Address - Fax:
Practice Address - Street 1:2132 6TH AVE SE STE 505
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6580
Practice Address - Country:US
Practice Address - Phone:256-648-5624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty