G Teal Dick, M.DIV. LPC-S
Individual provider Active NPI Professional Counselor · Thorsby, AL
NPI 1730355017 · NPPES record last updated Oct 27, 2014
Key facts
- NPI
- 1730355017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 1489 (AL)
- Practice address
- 1881 County Road 627
Thorsby, AL 35171-8151 - Phone
- (205) 389-2079
- NPI assigned
- May 6, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Still Waters Counseling and Education Center
Practice addresses (Care Compare)
400 Office Park Dr
Suite 230
Mountain BRK, AL 35223-3410
Phone (205) 825-1423
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250623000543 | AL | Practitioner - Mental Health Counselor | 3173035557 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1489 | AL | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Still Waters Counseling and Education Center | Current |
Accepting new patients | |
| Alabama Family Resource Center, PC | Professional | Past | Accepting new patients |
Locations
400 Office Park Dr
Ste 230
Mountain Brk, AL 35223
Phone (205) 825-1423
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1489 | AL | Yes |
Addresses
Primary practice location
1881 County Road 627
Thorsby, AL 35171-8151
Mailing address
P.O. Box 55
Thorsby, AL 35171-3428
Phone (205) 389-2079
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11812892 | Other | CAQH | |
| 515-45395 | Other | AL | BLUE CROSS BLUE SHIELD |
Other providers in Thorsby, AL
- Jessica Clare Broussard
- Josephine Brown
- Cenrtal Alabama Medical Associates
- Chilton Family Medicine, P.C.
- Clanton Hospital LLC
- Claud Griffin Hornsby
- Keela Ray
- Southeastern Med Consultants, LLC.
- Thorsby Dental Clinic
- Thorsby Dental LLC
All providers in Thorsby, AL · Professional Counselor in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2014. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.