Mark Linden Prohaska, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

816 Issued in AL

Practice address

100 Rice Mine Road
Suite 303
Tuscaloosa, AL 35406

Phone

(205) 344-6169

Fax

(205) 344-6171

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neuropsychology Clinic

  • Clinical Neuropsychologist
  • Northport, AL
  • NPI 1093996985
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233878400000",
    "number": "1073663555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RICE MINE ROAD",
            "address_2": "SUITE 303",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "35406",
            "telephone_number": "205-344-6169",
            "fax_number": "205-344-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RICE MINE ROAD",
            "address_2": "SUITE 303",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "35406",
            "telephone_number": "205-344-6169",
            "fax_number": "205-344-6171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROHASKA",
        "first_name": "MARK",
        "middle_name": "LINDEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2009-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AL",
            "license": "816",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AL",
            "license": "816",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51504930",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mike Pritchett, PHARMD
• Private Healthcare Facilities
• James Bradley Proctor, M.D.
• Professional Therapy Services Inc
• Progressive Environments for Tuscaloosa Residents Alliance, Inc
• Tempest Lucindra Prude, FNP-C
• Amanda Prusak, MA, ATC, LAT
• Psychiatric Corporation of Alabama
• Psychiatry South, Inc.
• Publix Alabama LLC

• Clinical Neuropsychologist in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Clinical Neuropsychologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.