MEDICARE: WESTERN MENTAL HEALTH CENTER 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659548444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN MENTAL HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	1701 AVENUE D
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218-1532
Country	:	US
Telephone Number	:	205-788-7770
Fax Number	:	205-788-7552

Provider Business Practice Location Address
First Line	:	1701 AVENUE D
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218-1532
Country	:	US
Telephone Number	:	205-788-7770
Fax Number	:	205-788-7552

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. TOM RAY HOBBS
Credential	:	PHD
Telephone Number	:	205-788-7770

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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