| Name: | Behavioral Pediatric Institute of Alabama, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 09 Jul 2012 (13 years ago) |
| Entity Number: | 000-070-770 |
| Register Number: | 000070770 |
| ZIP code: | 35243 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 3257 CAHABA HEIGHTS ROADBIRMINGHAM, AL 35243 |
Activities
PRACTICE OF PSYCHOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639426729 | 2012-08-08 | 2012-08-08 | 4 OFFICE PARK CIR STE 215A, MOUNTAIN BRK, AL, 352232533, US | 4 OFFICE PARK CIR STE 215A, MOUNTAIN BRK, AL, 352232533, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-414-6686 |
Authorized person
| Name | STEPHANIE BETHKE STOLL |
| Role | CLINICAL PSYCHOLOGIST |
| Phone | 2054146686 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| License Number | 11211750 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 103K00000X - Behavior Analyst |
| License Number | 1106821 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 103TC2200X - Clinical Child & Adolescent Psychologist |
| License Number | 1404 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 103TC2200X - Clinical Child & Adolescent Psychologist |
| License Number | 1715 |
| State | AL |
| Is Primary | No |
| Name | Role |
|---|---|
| LADDEN, STACY | Agent |
| Name | Role | Address |
|---|---|---|
| LEVY, JACK B | Incorporator | 1819 FIFTH AVENUE NBIRMINGHAM, AL 35203 |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
