| Eastside Mental Health Center Inc | |
|
129 E Park Cir Birmingham AL 35235-3000 | |
| (205) 836-7283 | |
| (205) 836-9594 |
| Full Name | Eastside Mental Health Center Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 129 E Park Cir, Birmingham, Alabama |
| Authorized Official Name and Position | Beverly Frances (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2058367283 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Mental Health Center Inc 129 E Park Cir Birmingham AL 35235-3000 Ph: (205) 836-7283 | Eastside Mental Health Center Inc 129 E Park Cir Birmingham AL 35235-3000 Ph: (205) 836-7283 |
| NPI Number | 1770637910 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 01/27/2020 |
| Certification Date | 01/27/2020 |
| Medicare PECOS PAC ID | 3577524362 |
|---|---|
| Medicare Enrollment ID | O20041025000828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770637910 | NPI | - | NPPES |
| 330000004 | Medicaid | AL | |
| 051008105 | Other | AL | PEEHIP STATE INSURANCE |
| I023 | Other | AL | MEDICARE GROUP BLOUNT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Romaine Hain |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154450385 PECOS PAC ID: 3072528462 Enrollment ID: I20060206000911 |
| Provider Name | Sandra Grooms |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811170582 PECOS PAC ID: 8123105756 Enrollment ID: I20080408000078 |
| Provider Name | Amjed Javaid |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447366653 PECOS PAC ID: 0941376388 Enrollment ID: I20080909000005 |
| Provider Name | Terri S Steele |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730108192 PECOS PAC ID: 1052445871 Enrollment ID: I20100816000941 |
| Provider Name | Shea Jones Watkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821157967 PECOS PAC ID: 1052500089 Enrollment ID: I20110106000756 |
| Provider Name | Badari Birur |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720276595 PECOS PAC ID: 3779755699 Enrollment ID: I20111018000563 |
| Provider Name | Mary Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841568300 PECOS PAC ID: 0244477081 Enrollment ID: I20130514000702 |
| Provider Name | Phillip Plemons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871840199 PECOS PAC ID: 8921321043 Enrollment ID: I20141222001826 |
| Provider Name | Yuliya Alekseevna Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407227861 PECOS PAC ID: 1759681505 Enrollment ID: I20151130001068 |
| Provider Name | Kimberly Elliott Hyden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295289031 PECOS PAC ID: 6507152279 Enrollment ID: I20160906001752 |
| Provider Name | Clifford A Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013562123 PECOS PAC ID: 5193033355 Enrollment ID: I20191010000776 |
| Provider Name | Simone C Durand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518382373 PECOS PAC ID: 8820499346 Enrollment ID: I20210622001176 |
| Provider Name | Lillian G Sudduth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356961932 PECOS PAC ID: 5698168664 Enrollment ID: I20220216000118 |
| Provider Name | Candance E Judkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679824973 PECOS PAC ID: 6103293386 Enrollment ID: I20221031003070 |
| Provider Name | Branch R. Acton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992494041 PECOS PAC ID: 3173970407 Enrollment ID: I20231108002531 |
| Provider Name | Tammie Bennett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326343963 PECOS PAC ID: 6608227509 Enrollment ID: I20240104002678 |
| Provider Name | Tanekia D Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497393581 PECOS PAC ID: 7416308325 Enrollment ID: I20240104003046 |
| Provider Name | Karen Lovvorn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932436870 PECOS PAC ID: 8224489463 Enrollment ID: I20240111003436 |
| Provider Name | David G Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134456072 PECOS PAC ID: 3870946007 Enrollment ID: I20240124002247 |
| Provider Name | Naquisha Calhoun |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548812084 PECOS PAC ID: 8426492935 Enrollment ID: I20240222002914 |
| Provider Name | Leah Frost |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336906213 PECOS PAC ID: 5991146581 Enrollment ID: I20240514002207 |
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