Bodenheimer Psychological & Counseling Center LLC
Organization Active NPI Clinical Psychologist · Anniston, AL
NPI 1972575272 · NPPES record last updated Aug 29, 2007
Key facts
- NPI
- 1972575272
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 978 (AL)
- Legal business name
- BODENHEIMER PSYCHOLOGICAL & COUNSELING CENTER LLC
- Practice address
- 1523 Leighton Ave
Anniston, AL 36207-3828 - Phone
- (256) 236-0070
- Fax
- (256) 237-0079
- NPI assigned
- Feb 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Lucile Bodenheimer, PSYD
- Title
- Licensed Clinical Psycholgist Owner
- Phone
- (256) 236-0070
Practitioners 2
-
Lucile Bodenheimer, PSY.D.
-
James W Holiday, LMFT,LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040218000590 | AL | Part B Supplier - Clinic/Group Practice | 3971498932 |
Receives reassigned benefits from 1 practitioner Practice locations: Anniston, AL |
National Provider Directory
Locations
1523 Leighton Ave
Anniston, AL 36207
Phone (256) 236-0070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 978 | AL | Yes |
Addresses
Primary practice location
1523 Leighton Ave
Anniston, AL 36207-3828
Mailing address
PO Box 952
Anniston, AL 36202-0952
Phone (256) 236-0070
Other names
- Lucile Bodenheimer
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- Samantha Keener Blanchet
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- Lucile Bodenheimer
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All providers in Anniston, AL · Clinical Psychologist in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2007. 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.