NPIMap

Organization Active NPI

Prokids, Inc.

  • Clinical Psychologist
  • Mobile, AL
National Provider Identifier
1235365172
Registry record updated Jun 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
AL1353 Issued in AL
Legal business name
PROKIDS, INC.
Practice address
321 Alpine St
Mobile, AL 36611-2434
Phone
(251) 457-4170
Fax
(251) 259-5177
NPI assigned
Jun 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2009

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

Authorized official

Name
Dr. David Louis Roberts, PH.D.
Title
President/Clinical Psychologist
Phone
(251) 457-4170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X AL1353 AL Primary

Addresses

Primary practice location

321 Alpine St
Mobile, AL 36611-2434

Mailing address

PO Box 11452
Mobile, AL 36671-0452
Phone (251) 457-4170

Other identifiers 1

IdentifierTypeStateIssuer
890013780MedicaidAL

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1244160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244160000000",
    "number": "1235365172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11452",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366710452",
            "telephone_number": "251-457-4170",
            "fax_number": "251-259-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 ALPINE ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366112434",
            "telephone_number": "251-457-4170",
            "fax_number": "251-259-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROKIDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-05",
        "last_updated": "2009-06-05",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT/CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "251-457-4170",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "AL1353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890013780",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.