Provider Demographics
NPI:1730372533
Name:CLEMENTS, CARL B (PH D)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:B
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 870348
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0001
Mailing Address - Country:US
Mailing Address - Phone:205-348-9694
Mailing Address - Fax:205-348-8648
Practice Address - Street 1:3701 LOOP RD
Practice Address - Street 2:BLDG 39
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5015
Practice Address - Country:US
Practice Address - Phone:205-562-3700
Practice Address - Fax:205-562-3769
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ08996Medicare UPIN