| |
810 Shoney Dr Sw Ste 120 Huntsville AL 35801-5450 | |
(256) 883-3231 | |
(256) 883-9577 |
Full Name | |
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Speciality | Community/Behavioral Health |
Location | 810 Shoney Dr Sw Ste 120, Huntsville, Alabama |
Authorized Official Name and Position | David Loren Barnhart (OWNER/PRESIDENT) |
Authorized Official Contact | 2568833231 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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810 Shoney Dr Sw Ste 120 Huntsville AL 35801-5450 Ph: (256) 883-3231 | 810 Shoney Dr Sw Ste 120 Huntsville AL 35801-5450 Ph: (256) 883-3231 |
NPI Number | 1942573100 |
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Provider Enumeration Date | 02/20/2012 |
Last Update Date | 11/14/2024 |
Certification Date | 11/14/2024 |
Medicare PECOS PAC ID | 7810144276 |
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Medicare Enrollment ID | O20120821000230 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942573100 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 170739 (Alabama) | Primary |
Provider Name | Judy C Park |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1497896567 PECOS PAC ID: 5193904589 Enrollment ID: I20110201000758 |
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