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General NPI Number Information
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NPI Number | 1952043788
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Entity Type | Individual
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Provider Name | SAMUEL JAY ALEX PSYD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 300 TWINING ST BLDG 760
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City | MONTGOMERY
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State | AL
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Zip | 36112-6027
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Country | US
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Telephone | 334-953-5430
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Fax |
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Provider Business Mailing Address
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Address Line | 300 TWINING ST BLDG 760
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City | MONTGOMERY
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State | AL
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Zip | 36112-6027
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Country | US
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Telephone | 334-953-5430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0810008288
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License Number State | VA
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