| Name: | IntellectualSoul Clinical Consulting, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 10 Mar 2021 (4 years ago) (Companies founded in March 2021) |
| Entity Number: | 000-839-816 |
| Register Number: | 000839816 |
| ZIP code: | 36106 (Companies in Montgomery, 36106) |
| County: | Montgomery |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 2541 College StreetMontgomery, AL 36106 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912559675 | 2019-07-12 | 2021-03-12 | 2541 COLLEGE ST, MONTGOMERY, AL, 361062124, US | 2541 COLLEGE ST, MONTGOMERY, AL, 361062124, US | |||||||||||||||
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| Phone | +1 334-207-7657 |
| Fax | 3343236747 |
Authorized person
| Name | DR. STEPHAN IDRIS MAMBAZO |
| Role | OWNER/PRIMARY PROVIDER |
| Phone | 3346259617 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
| Name | Role |
|---|---|
| Mambazo, Stephan I | Agent |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
