Healthcare Provider Details

I. General information

NPI: 1356689277
Provider Name (Legal Business Name): OVER THE MOUNTAIN PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTERVIEW DR SUITE 110
VESTAVIA AL
35216-3747
US

IV. Provider business mailing address

100 CENTERVIEW DR SUITE 110
VESTAVIA AL
35216-3747
US

V. Phone/Fax

Practice location:
  • Phone: 205-492-1973
  • Fax:
Mailing address:
  • Phone: 205-492-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1432
License Number StateAL

VIII. Authorized Official

Name: DR. AMY COOPER
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 205-453-9228