Alan D Blotcky Phd Llc | |
529 Beacon Pkwy W Ste 107 Birmingham AL 35209-3126 | |
(205) 912-7171 | |
Not Available |
Full Name | Alan D Blotcky Phd Llc |
---|---|
Speciality | Psychologist |
Location | 529 Beacon Pkwy W Ste 107, Birmingham, Alabama |
Authorized Official Name and Position | Alan Blotcky (OWNER) |
Authorized Official Contact | 2059127171 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Alan D Blotcky Phd Llc 973 Viridian Way Birmingham AL 35226-2810 Ph: () - | Alan D Blotcky Phd Llc 529 Beacon Pkwy W Ste 107 Birmingham AL 35209-3126 Ph: (205) 912-7171 |
NPI Number | 1285254755 |
---|---|
Provider Enumeration Date | 04/24/2020 |
Last Update Date | 04/29/2020 |
Certification Date | 04/29/2020 |
Medicare PECOS PAC ID | 9436580404 |
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Medicare Enrollment ID | O20200506001529 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285254755 | NPI | - | NPPES |
430 | Other | AL | LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Provider Name | Alan D Blotcky |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1053494773 PECOS PAC ID: 3779552831 Enrollment ID: I20200506001661 |
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