Provider Demographics
NPI:1861239030
Name:OAK MOUNTAIN COUNSELING LLC
Entity type:Organization
Organization Name:OAK MOUNTAIN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-441-4711
Mailing Address - Street 1:5160 HOLLOW LOG LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1924
Mailing Address - Country:US
Mailing Address - Phone:205-441-4711
Mailing Address - Fax:
Practice Address - Street 1:450B CENTURY PARK S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3910
Practice Address - Country:US
Practice Address - Phone:205-441-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health