Healthcare Provider Details

I. General information

NPI: 1629819248
Provider Name (Legal Business Name): BEHAVIORAL HEALTH REIMAGINED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BEARDEN RD
PELHAM AL
35124-1715
US

IV. Provider business mailing address

230 BEARDEN RD
PELHAM AL
35124-1715
US

V. Phone/Fax

Practice location:
  • Phone: 205-358-7686
  • Fax: 877-940-3057
Mailing address:
  • Phone: 205-358-7686
  • Fax: 877-940-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KARLI MARTIN
Title or Position: CEO
Credential: PSYD
Phone: 205-358-7686