| Intellectualsoul Clinical Consulting, Llc | |
|
2541 College St Montgomery AL 36106-2124 | |
| (334) 207-7657 | |
| (334) 323-6747 |
| Full Name | Intellectualsoul Clinical Consulting, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2541 College St, Montgomery, Alabama |
| Authorized Official Name and Position | Stephan Idris Mambazo (OWNER/PRIMARY PROVIDER) |
| Authorized Official Contact | 3346259617 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intellectualsoul Clinical Consulting, Llc 2541 College St Montgomery AL 36106-2124 Ph: (334) 207-7657 | Intellectualsoul Clinical Consulting, Llc 2541 College St Montgomery AL 36106-2124 Ph: (334) 207-7657 |
| NPI Number | 1912559675 |
|---|---|
| Provider Enumeration Date | 07/12/2019 |
| Last Update Date | 03/12/2021 |
| Certification Date | 03/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912559675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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