Healthcare Provider Details

I. General information

NPI: 1417902032
Provider Name (Legal Business Name): MELISSA V CLINGER PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CONCOURSE PKWY STE 101
BIRMINGHAM AL
35244
US

IV. Provider business mailing address

100 CONCOURSE PKWY STE 101
BIRMINGHAM AL
35244
US

V. Phone/Fax

Practice location:
  • Phone: 205-444-0420
  • Fax: 205-403-0747
Mailing address:
  • Phone: 205-444-0420
  • Fax: 205-403-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number650
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: