Healthcare Provider Details

I. General information

NPI: 1669387361
Provider Name (Legal Business Name): TIMOTHY ALAN STANDRIDGE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CARMICHAEL WAY
MONTGOMERY AL
36106-3691
US

IV. Provider business mailing address

397 COUNTY ROAD 33
AUTAUGAVILLE AL
36003-2733
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-4900
  • Fax:
Mailing address:
  • Phone: 251-362-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: