Healthcare Provider Details

I. General information

NPI: 1205904836
Provider Name (Legal Business Name): BEACON PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BEACON PKWY W SUITE 850
BIRMINGHAM AL
35209-3120
US

IV. Provider business mailing address

600 BEACON PARKWAY WEST SUITE 850
BIRMINGHAM AL
35210
US

V. Phone/Fax

Practice location:
  • Phone: 205-945-1550
  • Fax: 205-945-1260
Mailing address:
  • Phone: 205-945-1550
  • Fax: 205-945-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number848
License Number StateAL

VIII. Authorized Official

Name: SAMANTHA RYAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-945-1550