Healthcare Provider Details

I. General information

NPI: 1437390853
Provider Name (Legal Business Name): ALABAMA NEUROBEHAVIOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2009
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 23RD ST S
BIRMINGHAM AL
35205-2499
US

IV. Provider business mailing address

321 DELCRIS CT
BIRMINGHAM AL
35226-1978
US

V. Phone/Fax

Practice location:
  • Phone: 205-837-3533
  • Fax:
Mailing address:
  • Phone: 205-837-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1206
License Number StateAL

VIII. Authorized Official

Name: DR. KRISTINE LOKKEN EDMONDSON
Title or Position: NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 205-837-3533