NPIMap

Organization Active NPI

East Alabama Center for Change, LLC

  • Clinical Psychologist
  • Auburn, AL
National Provider Identifier
1902280126
Registry record updated Jul 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
AL1749 Issued in AL
Legal business name
EAST ALABAMA CENTER FOR CHANGE, LLC
Practice address
124 Bragg Ave
Auburn, AL 36830-3809
Phone
(334) 734-2603
Fax
(334) 887-0031
NPI assigned
Jul 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2015

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

Authorized official

Name
Amber Elizabeth Douglas, PSYDNPI 1659625986
Title
Licensed Psychologist
Phone
(334) 734-2603

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X AL1749 AL Primary
Health PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TH0004X AL1749 AL

Addresses

Primary practice location

124 Bragg Ave
Auburn, AL 36830-3809

Mailing address

124 Bragg Ave
Auburn, AL 36830-3809
Phone (334) 734-2603

Other identifiers 1

IdentifierTypeStateIssuer
102I626774OtherALMEDICARE PTAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437091200000",
    "number": "1902280126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 BRAGG AVE",
            "city": "AUBURN",
            "state": "AL",
            "postal_code": "368303809",
            "telephone_number": "334-734-2603",
            "fax_number": "334-887-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 BRAGG AVE",
            "city": "AUBURN",
            "state": "AL",
            "postal_code": "368303809",
            "telephone_number": "334-734-2603",
            "fax_number": "334-887-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ALABAMA CENTER FOR CHANGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "334-734-2603",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "AL1749",
            "primary": true
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": "AL",
            "license": "AL1749",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "102I626774",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Auburn, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; 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.