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General NPI Number Information
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NPI Number | 1467670885
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Entity Type | Organization
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Legal Business Name | THE UNIVERSITY OF ALABAMA PSYCHOLOGY CLINIC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 505 HACKBERRY LN 251A GORDON PALMER
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City | TUSCALOOSA
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State | AL
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Zip | 35487-0001
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Country | US
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Telephone | 205-348-5003
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Fax | 205-348-5002
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Provider Business Mailing Address
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Address Line | PO BOX 870356 251A GORDON PALMER
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City | TUSCALOOSA
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State | AL
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Zip | 35487-0001
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Country | US
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Telephone | 205-348-5003
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Fax | 205-348-5002
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. MELISSA F. JACKSON
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Credential | PH.D.
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Telephone | 205-348-5003
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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 | 1322
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License Number State | AL
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