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General NPI Number Information
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NPI Number | 1225672058
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Entity Type | Organization
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Legal Business Name | CSP PSYCHIATRY LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 4505 PINE TREE CIR STE 201
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City | VESTAVIA
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State | AL
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Zip | 35243-2380
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Country | US
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Telephone | 205-453-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 PINE TREE CIR STE 201
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City | VESTAVIA
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State | AL
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Zip | 35243-2380
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Country | US
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Telephone | 205-453-4325
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Fax |
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Authorized Official
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Title or Position | BILLER /CREDENTIALING
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Name | KRISTEN AYCOCK
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Credential | CPB
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Telephone | 205-968-1227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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