Provider Demographics
NPI:1104939610
Name:MENEESE, WILLIAM B (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:MENEESE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660685
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0685
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:1 W LAKESHORE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-0500
Practice Address - Country:US
Practice Address - Phone:205-602-9980
Practice Address - Fax:205-592-8835
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL647103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000090974Medicaid
AL51090974OtherBCBS #
AL000090974Medicaid
ALR62893Medicare UPIN