Healthcare Provider Details

I. General information

NPI: 1912073354
Provider Name (Legal Business Name): ADULT & ADOLESCENT PSYCHOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PROVIDENCE PARK SUITE 250
BIRMINGHAM AL
35242-4697
US

IV. Provider business mailing address

1800 PROVIDENCE PARK SUITE 250
BIRMINGHAM AL
35242-4697
US

V. Phone/Fax

Practice location:
  • Phone: 205-995-1129
  • Fax: 205-949-0965
Mailing address:
  • Phone: 205-995-1129
  • Fax: 205-949-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number07004036
License Number StateAL

VIII. Authorized Official

Name: DR. RICHARD EDISON BETH
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 205-995-1129