| Name: | Anna Ford Smith Art Therapy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 11 Jun 2015 (9 years ago) |
| Entity Number: | 000-337-789 |
| Register Number: | 000337789 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 200 OFFICE PARK DRIVE SUITE 218MOUNTAIN BROOK, AL 35223 |
| Registered Office Street Address ZIP Code: | 35223 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942765466 | 2019-02-08 | 2019-02-08 | 303 WILLIAMS AVE SW STE 221, HUNTSVILLE, AL, 358016001, US | 303 WILLIAMS AVE SW STE 221, HUNTSVILLE, AL, 358016001, US | |||||||||||||||||||||||||
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| Phone | +1 256-715-2356 |
Authorized person
| Name | MRS. ANNA FORD SMITH |
| Role | OWNER/THERAPIST |
| Phone | 2567152356 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1073097911 |
| State | AL |
| Issuer | MEDICAID |
| Number | 1356608350 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SMITH, ANNA FORD | Organizer | 200 OFFICE PARK DRIVE SUITE 218MOUNTAIN BROOK, AL 35223 |
| BEAM, MATTHEW Y | Organizer | 2100 FIRST AVENUE N SUITE 600BIRMINGHAM, AL 35203 |
| Name | Role |
|---|---|
| SMITH, ANNA F | Agent |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
