Organization
CSP PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN AYCOCK CPB (BILLER /CREDENTIALING)
(205) 968-1227
Entity
Organization
Contact information
Practice address
4505 PINE TREE CIR STE 201, VESTAVIA, AL 35243-2380
(205) 453-4325
Mailing address
4505 PINE TREE CIR STE 201, VESTAVIA, AL 35243-2380
(205) 453-4325
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09320028
—
MS
05
—
149645
—
AL
05
—
149766
—
AL
05
—
150204
—
AL
05
—
150612
—
AL
Enumeration date
11/05/2019
Last updated
11/05/2019
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