Healthcare Provider Details

I. General information

NPI: 1699196543
Provider Name (Legal Business Name): JOHN FRIEND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N UNIVERSITY BLVD
MOBILE AL
36608-3053
US

IV. Provider business mailing address

2100 VENETIA RD
MOBILE AL
36605-2819
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-7149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1835
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: