MEDICARE: PSYCHIATRY 280 COUNSELING SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	1048511	AL

General Provider Information

NPI Number	:	1285019927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRY 280 COUNSELING SERVICES INC

Provider Business Mailing Address
First Line	:	2803 GREYSTONE COMMERCIAL BLVD STE 12
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-9603
Country	:	US
Telephone Number	:	205-968-1227
Fax Number	:	205-968-1229

Provider Business Practice Location Address
First Line	:	2803 GREYSTONE COMMERCIAL BLVD STE 12
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-9603
Country	:	US
Telephone Number	:	205-968-1227
Fax Number	:	205-968-1229

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	LANE GOULD-HARTLINE
Credential	:	APRN
Telephone Number	:	205-968-1227

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	03/15/2018

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