Healthcare Provider Details

I. General information

NPI: 1801842588
Provider Name (Legal Business Name): JOSEPH GILLESPIE LAW JR. MS EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BEL AIR BLVD SUITE 24
MOBILE AL
36606-3514
US

IV. Provider business mailing address

605 BEL AIR BLVD SUITE 24
MOBILE AL
36606-3514
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-0000
  • Fax: 866-267-9054
Mailing address:
  • Phone: 251-450-0000
  • Fax: 866-267-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH4029
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number345
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number1064
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: