| Name: | Smiths Station and Phenix City Psychological P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 16 Dec 2009 (15 years ago) (Companies founded in December 2009) |
| Entity Number: | 000-262-762 |
| Register Number: | 000262762 |
| ZIP code: | 36877 (Companies in Lee, 36877) |
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | SMITHS STATION, AL |
| Registered Office Street Address: | 2061 LEE ROAD 430SMITHS STATION, AL 36877 |
| Registered Office Mailing Address: | 2926 MCKINLEY DRIVEOPELIKA, AL 36804 |
| Authorized Capital: | 100 |
Activities
PSYCHOLOGICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952549529 | 2009-02-04 | 2012-08-29 | 475 NOTTINGHAM DR, AUBURN, AL, 368306464, US | 2061LEE ROAD 430, SMITHS STATION, AL, 368772307, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 334-577-4978 |
| Fax | 3344084518 |
Authorized person
| Name | DR. PAUL RODNEY GUINANE |
| Role | LICENSED PSYCHOLOGIST |
| Phone | 3345774978 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | 1445 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | TYPE II NPI |
| Number | 1952549529 |
| State | AL |
| Issuer | TYPE I NPI |
| Number | 1134210743 |
| State | GA |
| Issuer | MEDICAID |
| Number | 118063 |
| State | AL |
| Name | Role |
|---|---|
| BLOCH, ERIC | Agent |
| Name | Role |
|---|---|
| GUINANE, PAUL | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
