Intellectualsoul Clinical Consulting, LLC
NPI #1912559675 in Montgomery, Alabama
Provider Information
- NPI Number
- 1912559675
- Entity Type
- Organization
- Organization Name
- Intellectualsoul Clinical Consulting, LLC
- Primary Specialty
- Community/Behavioral Health
- Enumeration Date
- Jul 12, 2019
- Last Updated
- Mar 12, 2021
Practice Location
- Address
- 2541 COLLEGE ST
- City
- Montgomery
- State
- Alabama
- ZIP Code
- 36106-2124
- Phone
- (334) 207-7657
Authorized Official
- Name
- DR. STEPHAN IDRIS MAMBAZO, LICSW
- Title
- OWNER/PRIMARY PROVIDER
- Phone
- (334) 625-9617
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community/Behavioral Health |
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