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General NPI Number Information
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NPI Number | 1285254755
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Entity Type | Organization
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Legal Business Name | ALAN D BLOTCKY PHD LLC
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 529 BEACON PKWY W STE 107
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3126
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Country | US
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Telephone | 205-912-7171
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Fax |
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Provider Business Mailing Address
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Address Line | 973 VIRIDIAN WAY
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City | BIRMINGHAM
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State | AL
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Zip | 35226-2810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALAN BLOTCKY
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Credential | PHD
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Telephone | 205-912-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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