| Name: | Clinical Psychologists, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 30 Jun 1980 (44 years ago) |
| Entity Number: | 000-061-831 |
| Register Number: | 000061831 |
| Historical Names: |
Burkhart, Kelley and King, Clinical Psychologists, P.C.
Burkhart, Kelley, King and Kirkland, Clinical Psychologists, P.C. Burkhart and Kelley, Clinical Psychologists, P.C. |
| Place of Formation: | Lee County |
| Authorized Capital: | $2,400 |
| Paid Share Capital: | $1,200 |
Activities
TO RENDER PROFESSIONAL MENTAL HEALTH SERVICES TO THE PUBLIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841221272 | 2006-07-05 | 2020-08-22 | 248 E GLENN AVE, AUBURN, AL, 368304818, US | 248 E GLENN AVE, AUBURN, AL, 368304818, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-821-3350 |
| Fax | 3348213252 |
Authorized person
| Name | DR. CRYSTAL KELLEY |
| Role | PRESIDENT/CLINICAL PSYCHOLOGIST |
| Phone | 3348213350 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | 578 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | 607 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | 181 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51509821 |
| State | AL |
| Issuer | BCBS |
| Number | 70628 |
| State | AL |
| Issuer | BCBS |
| Number | 70627 |
| State | AL |
| Issuer | BCBS |
| Number | 72343 |
| State | AL |
| Issuer | BCBS |
| Number | 51003710 |
| State | AL |
| Issuer | BCBS |
| Number | 73346 |
| State | AL |
| Issuer | BCBS |
| Number | 51533748 |
| State | AL |
| Issuer | BCBS |
| Number | 51533703 |
| State | AL |
| Issuer | BCBS |
| Number | 72183 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BURKHART, BARRY R | Incorporator | No data |
| KELLEY, CRYSTAL K | Incorporator | No data |
| KING, GLEN D | Incorporator | 1737 FAIRWAY DRIVEAUBURN, AL 38630 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2021-04-05 | Name Change | Burkhart and Kelley, Clinical Psychologists, P.C. | Clinical Psychologists, P.C. |
| 1993-03-03 | Name Change | Burkhart, Kelley, King and Kirkland, Clinical Psychologists, P.C. | Burkhart and Kelley, Clinical Psychologists, P.C. |
| 1986-10-09 | Name Change | Burkhart, Kelley and King, Clinical Psychologists, P.C. | Burkhart, Kelley, King and Kirkland, Clinical Psychologists, P.C. |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
