MEDICARE: CALVERT AND ASSOCIATES, 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	101YM0800X	Mental Health Counselor	1961	AL

General Provider Information

NPI Number	:	1811431109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVERT AND ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	5184 CALDWELL MILL RD
Second Line	:	SUITE 204-290 (MAIL ONLY)
City	:	HOOVER
State	:	AL
Zip	:	35244-1912
Country	:	US
Telephone Number	:	205-918-6161
Fax Number	:	888-972-6921

Provider Business Practice Location Address
First Line	:	402 OFFICE PARK DR
Second Line	:	SUITE 300B
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2417
Country	:	US
Telephone Number	:	205-918-6161
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MANDY CALVERT
Credential	:
Telephone Number	:	205-918-6161

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	02/16/2017

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