Healthcare Provider Details

I. General information

NPI: 1003368671
Provider Name (Legal Business Name): NORTH ALABAMA FAMILY PSYCHIATRY & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9238 MADISON BLVD SUITE 750
MADISON AL
35758-9100
US

IV. Provider business mailing address

9238 MADISON BLVD SUITE 750
MADISON AL
35758-9100
US

V. Phone/Fax

Practice location:
  • Phone: 256-727-8880
  • Fax: 888-951-7515
Mailing address:
  • Phone: 256-727-8880
  • Fax: 888-951-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE Y PETTWAY
Title or Position: PRESIDENT
Credential:
Phone: 256-724-8880