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WFR Behavioral ONE, LLC.

Details

Name: WFR Behavioral ONE, LLC.
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 21 Aug 2015 (9 years ago)
Entity Number: 000-343-953
Register Number: 000343953
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 1025 MONTGOMERY HWY STE #214VESTAVIA, AL 35216
Registered Office Street Address ZIP Code: 35216
Registered Office Mailing Address: 1809 GLENDMERE DRIVEVESTAVIA, AL 35216
Registered Office Mailing Address ZIP Code: 35216

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1083086052 2015-10-29 2015-10-29 1025 MONTGOMERY HWY, SUITE #214, VESTAVIA, AL, 352162845, US 1025 MONTGOMERY HWY, SUITE #214, VESTAVIA, AL, 352162845, US

Contacts

Phone +1 205-233-1414
Fax 2058222732

Authorized person

Name MR. WILLIAM RICHARDSON
Role OWNER/SCHOOL PSYCHOLOGIST
Phone 2052331414

Taxonomy

Taxonomy Code 103K00000X - Behavior Analyst
License Number 1-15-19295
State AL
Is Primary Yes
Taxonomy Code 103TS0200X - School Psychologist
License Number WXR-01058632
State AL
Is Primary No

Other Provider Identifiers

Issuer MEDICAID
Number 1588615918
State SC

Agent

Name Role Address
RICHARDSON, WILLIAM Agent 402 6TH AVENUE SWDECATUR, AL 35601

Date of last update: 03 Aug 2024

Sources: Alabama Secretary of State