Alabama Psychotherapy & Wellness Center, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1996-10-01
Business code	621330
Sponsor’s telephone number	2059122000
Plan sponsor’s address	3 OFFICE PARK CIRCLE, SUITE 115, MOUNTAIN BROOK, AL, 35223

Plan administrator’s name and address

Administrator’s EIN	631155509
Plan administrator’s name	ALABAMA PSYCHOTHERAPY & WELLNESS CENTER, P.C.
Plan administrator’s address	3 OFFICE PARK CIRCLE, SUITE 115, MOUNTAIN BROOK, AL, 35223
Administrator’s telephone number	2059122000

Signature of

Role	Plan administrator
Date	2012-04-10
Name of individual signing	RUTH ANN LYMAN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1996-10-01
Business code	621330
Sponsor’s telephone number	2059122000
Plan sponsor’s address	3 OFFICE PARK CIRCLE, SUITE 115, MOUNTAIN BROOK, AL, 35223

Plan administrator’s name and address

Administrator’s EIN	631155509
Plan administrator’s name	ALABAMA PSYCHOTHERAPY & WELLNESS CENTER, P.C.
Plan administrator’s address	3 OFFICE PARK CIRCLE, SUITE 115, MOUNTAIN BROOK, AL, 35223
Administrator’s telephone number	2059122000

Signature of

Role	Plan administrator
Date	2011-06-29
Name of individual signing	RUTH ANN LYMAN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1996-10-01
Business code	621330
Sponsor’s telephone number	2059122000
Plan sponsor’s address	631 BEACON PARKWAY WEST, BIRMINGHAM, AL, 35209

Plan administrator’s name and address

Administrator’s EIN	631155509
Plan administrator’s name	ALABAMA PSYCHOTHERAPY & WELLNESS CENTER, P.C.
Plan administrator’s address	631 BEACON PARKWAY WEST, BIRMINGHAM, AL, 35209
Administrator’s telephone number	2059122000

Signature of

Role	Plan administrator
Date	2010-10-06
Name of individual signing	RUTH ANN LYMAN

Three-digit plan number (PN)	001
Effective date of plan	1996-10-01
Business code	621330
Sponsor’s telephone number	2059122000
Plan sponsor’s address	631 BEACON PARKWAY WEST, BIRMINGHAM, AL, 35209

Plan administrator’s name and address

Administrator’s EIN	631155509
Plan administrator’s name	ALABAMA PSYCHOTHERAPY & WELLNESS CENTER, P.C.
Plan administrator’s address	631 BEACON PARKWAY WEST, BIRMINGHAM, AL, 35209
Administrator’s telephone number	2059122000

Signature of

Role	Plan administrator
Date	2010-10-05
Name of individual signing	RUTH ANN LYMAN

Unique Award Key	CONT_IDV_SS040960002_2800
Awarding Agency	Social Security Administration
Link	View Page

Description

Title	MEDICAL CONSULTANT SERVICES - PSYCHIATRY
NAICS Code	621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes	Q526: MEDICAL/PSYCH CONSULTATION SVCS

Recipient Details

Recipient	ALABAMA PSYCHOTHERAPY & WELLNESS CENTER, P.C.
UEI	XS3VXLYAGDM6
Legacy DUNS	966898504
Recipient Address	UNITED STATES, 631 BEACON PKWY W SUITE 203, BIRMINGHAM, 352093131