Name: | KELLY FOUNTAIN, M.S., L.P.T., L.L.C. |
Jurisdiction: | Alabama |
Legal type: | Domestic Limited Liability Company |
Status: | Exists |
Date of registration: | 30 Jan 2013 (12 years ago) (Companies founded in January 2013) |
Entity Number: | 000-273-531 |
Register Number: | 000273531 |
ZIP code: | 36606 (Companies in Mobile, 36606) |
County: | Mobile |
Place of Formation: | Mobile County |
Principal Address: | 2864 DAUPHIN STREET SUITE AMOBILE, AL 36606 |
Activities
PHYCHOLOGICAL SERVICES
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1154714384 | 2015-03-12 | 2015-03-12 | 2864 DAUPHIN ST, SUITE A, MOBILE, AL, 366062479, US | 2864 DAUPHIN ST, SUITE A, MOBILE, AL, 366062479, US | |||||||||||||||||||||||||||||
|
Phone | +1 251-470-7607 |
Authorized person
Name | KELLY FOUNTAIN |
Role | OWNER |
Phone | 2514707607 |
Taxonomy
Taxonomy Code | 101Y00000X - Counselor |
License Number | 1586 |
State | AL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | NPI |
Number | 1003148487 |
State | AL |
Issuer | BLUE CROSS BLUE SHIELD |
Number | 511-33704 |
State | AL |
Name | Role | Address |
---|---|---|
FOUNTAIN, KELLY | Agent | 2864 DAUPHIN STREET SUITE AMOBILE, AL 36606 |
Name | Role | Address |
---|---|---|
FOUNTAIN, KELLY | Organizer | 2864 DAUPHIN STREET SUITE AMOBILE, AL 36606 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State