Provider Demographics
NPI:1285809194
Name:MENTAL HEALTH BOARD OF BIBB PICKENS AND TUSCALOOSA COUNTIES
Entity type:Organization
Organization Name:MENTAL HEALTH BOARD OF BIBB PICKENS AND TUSCALOOSA COUNTIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-562-3700
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2190
Mailing Address - Country:US
Mailing Address - Phone:205-562-3700
Mailing Address - Fax:205-562-3769
Practice Address - Street 1:1915 6TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1722
Practice Address - Country:US
Practice Address - Phone:205-562-3700
Practice Address - Fax:205-562-3769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH BOARD OF BIBB PICKENS AND TUSCALOOSA COUNTIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528700510Medicaid
AL051008111OtherBCBS OF AL
AL051511693OtherBCBS OF AL