| Name: | Neuropsychology Clinic P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 18 Jun 2001 (23 years ago) |
| Entity Number: | 000-217-139 |
| Register Number: | 000217139 |
| Historical Names: |
Neuropsychology P.C.
|
| Place of Formation: | Tuscaloosa County |
| Principal Address: | NORTHPORT, AL |
| Registered Office Street Address: | 2804 20TH AVENORTHPORT, AL 35426 |
| Authorized Capital: | 25,000,000 |
Activities
NEUROPSYCHOLOGY CLINIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093996985 | 2007-11-19 | 2010-05-05 | 2804 20TH AVE, NORTHPORT, AL, 354763835, US | 2804 20TH AVE, NORTHPORT, AL, 354763835, US | |||||||||||||||||||||||||
|
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| Phone | +1 205-333-1404 |
| Fax | 2053331516 |
Authorized person
| Name | MARK L PROHASKA |
| Role | DIRECTOR |
| Phone | 2053446169 |
Taxonomy
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| License Number | 816 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 51504930 |
| State | AL |
| Name | Role |
|---|---|
| PROHASKA, MARK L | Agent |
| Name | Role |
|---|---|
| OSTER, RICHARD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2001-09-10 | Name Change | Neuropsychology P.C. | Neuropsychology Clinic P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
