Healthcare Provider Details

I. General information

NPI: 1659502193
Provider Name (Legal Business Name): HARLAN HOBART GROOMS III M. DIV., M. ED. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BART GROOMS M. DIV., M. ED. LPC

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2872 ACTON RD
BIRMINGHAM AL
35243-2502
US

IV. Provider business mailing address

2872 ACTON RD
BIRMINGHAM AL
35243-2502
US

V. Phone/Fax

Practice location:
  • Phone: 205-795-7734
  • Fax: 205-967-3664
Mailing address:
  • Phone: 205-795-7734
  • Fax: 205-967-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1720
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberL138
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: