MEDICARE: PSYCHOLOGICAL CARE SERVICES OF AL, 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	1041C0700X	Clinical Social Worker
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1861759219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGICAL CARE SERVICES OF AL, LLC

Provider Business Mailing Address
First Line	:	109 DOUBLOON DR
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-2715
Country	:	US
Telephone Number	:	985-641-2513
Fax Number	:	985-265-4155

Provider Business Practice Location Address
First Line	:	1 PERIMETER PARK S
Second Line	:	STE 100N
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2327
Country	:	US
Telephone Number	:	985-641-2513
Fax Number	:	985-265-4155

Authorized Official
Title or Position	:	SOLE MBR
Name	:	GERTRUDE M PARKER
Credential	:
Telephone Number	:	985-641-2513

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	08/21/2013

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