Provider Demographics
NPI:1558177733
Name:BYNUM, ELIZABETH B (ALC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:BYNUM
Suffix:
Gender:F
Credentials:ALC
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 1324
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-1324
Mailing Address - Country:US
Mailing Address - Phone:888-355-7080
Mailing Address - Fax:256-615-8632
Practice Address - Street 1:198 US HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-0690
Practice Address - Country:US
Practice Address - Phone:888-355-7080
Practice Address - Fax:256-615-8632
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health