| Name: | Karl Kirkland, Ph.D, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 26 May 2016 (8 years ago) (Companies founded in May 2016) |
| Date of dissolution: | 31 Dec 2020 |
| Entity Number: | 000-363-633 |
| Register Number: | 000363633 |
| ZIP code: | 36117 (Companies in Montgomery, 36117) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 8650 MINNIE BROWN ROAD, STE 116MONTGOMERY, AL 36117 |
| Authorized Capital: | 100 @ $1.00 PV |
Activities
TO ENGAGE IN THE BUSINESS OF THE PRACTICE O PSYCHOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851740971 | 2016-06-09 | 2016-07-11 | 8650 MINNIE BROWN RD, SUITE 116, MONTGOMERY, AL, 361177803, US | 8650 MINNIE BROWN RD, SUITE 116, MONTGOMERY, AL, 361177803, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-215-4466 |
| Fax | 3342154469 |
Authorized person
| Name | MR. KARL KIRKLAND |
| Role | PRESIDENT |
| Phone | 3342154466 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | 341 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 166424 |
| State | AL |
| Issuer | MEDICAID |
| Number | 890007150 |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7NWG7 | Obsolete | Non-Manufacturer | 2016-07-26 | 2022-07-21 | 2022-07-20 | No data | |||||||||||||
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| POC | TARA SHUFFITT |
| Phone | +1 334-215-4466 |
| Address | 8650 MINNIE BROWN RD STE 116, MONTGOMERY, AL, 36117 7433, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role | Address |
|---|---|---|
| KIRKLAND, KARL | Agent | 8650 MINNIE BROWN ROAD, STE 116MONTGOMERY, AL 36117 |
| Name | Role | Address |
|---|---|---|
| KIRKLAND, KARL | Director | 8650 MINNIE BROWN ROAD, STE 116MONTGOMERY, AL 36117 |
| Name | Role | Address |
|---|---|---|
| KIRKLAND, KARL | Incorporator | 8650 MINNIE BROWN ROAD, STE 116MONTGOMERY, AL 36117 |
Date of last update: 04 Aug 2024
Sources: Alabama Secretary of State
