Organization
NEUROPSYCHOLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK L PROHASKA PHD (DIRECTOR)
(205) 344-6169
Entity
Organization
Contact information
Practice address
2804 20TH AVE, NORTHPORT, AL 35476-3835
(205) 333-1404
(205) 333-1516
Mailing address
2804 20TH AVE, NORTHPORT, AL 35476-3835
(205) 333-1404
(205) 333-1516
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
816
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51504930
BLUE CROSS
AL
Enumeration date
11/19/2007
Last updated
05/05/2010
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