Provider Demographics
NPI:1407684822
Name:BOATRIGHT, BENJAMIN MERCER
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MERCER
Last Name:BOATRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1088
Mailing Address - Country:US
Mailing Address - Phone:205-737-3720
Mailing Address - Fax:205-752-0590
Practice Address - Street 1:420 28TH AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1088
Practice Address - Country:US
Practice Address - Phone:205-737-3720
Practice Address - Fax:205-752-0590
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health