MEDICARE: OAK MOUNTAIN COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1861239030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK MOUNTAIN COUNSELING LLC

Provider Business Mailing Address
First Line	:	5160 HOLLOW LOG LN
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-1924
Country	:	US
Telephone Number	:	205-441-4711
Fax Number	:

Provider Business Practice Location Address
First Line	:	450B CENTURY PARK S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-3910
Country	:	US
Telephone Number	:	205-441-4711
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMY ROBUCK
Credential	:	LPC
Telephone Number	:	205-441-4711

Provider Enumeration Date	:	07/13/2024
Last Update Date	:	07/13/2024

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Directions to “OAK MOUNTAIN COUNSELING LLC ” Practice Location

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