| Name: | My Psychiatry Clinic, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 27 Jun 2019 (5 years ago) |
| Entity Number: | 000-580-049 |
| Register Number: | 000580049 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 7021 LAKESIDE FARMS CIRCLEMCCALLA, AL 35111 |
| Registered Office Street Address ZIP Code: | 35111 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013540376 | 2020-02-14 | 2020-02-14 | 2021 SHADY CREST DR. SUITE 100, HOOVER, AL, 35216, US | 2021 SHADY CREST DR. SUITE 100, HOOVER, AL, 35216, US | |||||||||||||||||||||||||||
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| Phone | +1 205-536-6555 |
| Fax | 9804146282 |
Authorized person
| Name | MOHAMMAD AMINUL ISLAM |
| Role | CEO |
| Phone | 2055366555 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0802X - Addiction Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | No |
| Name | Role |
|---|---|
| ISLAM, MOHAMMAD A | Agent |
| Name | Role | Address |
|---|---|---|
| CLARKE, MICHAEL T | Organizer | 2324 SECOND AVENUE NORTHBIRMINGHAM, AL 35203 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
