MEDICARE: SELF RELIANCE BEHAVIORAL HEALTH, 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	:	1902790579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELF RELIANCE BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	2108 ROCKY RIDGE RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35216-5138
Country	:	US
Telephone Number	:	205-569-4770
Fax Number	:

Provider Business Practice Location Address
First Line	:	2108 ROCKY RIDGE RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35216-5138
Country	:	US
Telephone Number	:	205-569-4770
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	TAMIKA MICHELLE HARRIS
Credential	:	CRNP
Telephone Number	:	205-569-4770

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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