MEDICARE: GENESIS NEUROPSYCHIATRY, LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1669272860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS NEUROPSYCHIATRY, LLC

Provider Business Mailing Address
First Line	:	185 WHITESPORT DR SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-6486
Country	:	US
Telephone Number	:	256-880-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11743 COUNTY LINE RD STE C
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-3301
Country	:	US
Telephone Number	:	256-880-3500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. STEPHANIE L BLUME
Credential	:	CRNP, PMHNP-BC
Telephone Number	:	256-880-3500

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	01/29/2026

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