Behavioral Health of Selma, LLC
Organization Active NPI Psychologist · Selma, AL
NPI 1013148634 · NPPES record last updated Oct 6, 2009
Key facts
- NPI
- 1013148634
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- License
- 835 (AL)
- Legal business name
- BEHAVIORAL HEALTH OF SELMA, LLC
- Practice address
- 1306 Old Orrville Rd
Selma, AL 36701-6931 - Phone
- (334) 877-3322
- Fax
- (334) 877-3322
- NPI assigned
- Jul 30, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Richard Steven Reynolds, PH.D.
- Title
- Licensed Psychologist / Executive
- Phone
- (334) 877-3322
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090825000057 | AL | Part B Supplier - Clinic/Group Practice | 5496809550 |
Receives reassigned benefits from 1 practitioner Practice locations: Selma, AL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | 835 | AL | Yes |
Addresses
Primary practice location
1306 Old Orrville Rd
Selma, AL 36701-6931
Mailing address
1306 Old Orrville Rd
Selma, AL 36701-6931
Phone (334) 877-3322
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000113523 | Medicaid | AL |
Other providers in Selma, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.