Intown Pediatric Behavioral Wellness Llc
LBN: Intown Pediatric Behavioral Wellness Llc
Intown Pediatric Behavioral Wellness Llc is an health care organization with primary practice located at 340 Boulevard Ne Suite 345, Atlanta GA 30312-1273. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as the primary health care specialty.
Intown Pediatric Behavioral Wellness Llc can be contacted via phone (404) 653-0322, or through Poulos, Jennifer Lynn via phone (770) 656-1365.
Contact Information
Primary practice address
340 Boulevard Ne Suite 345
Atlanta GA 30312-1273
Phone: (404) 653-0322
Fax: (404) 653-0466
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | PSY003708 | Georgia |
Profile Details
| NPI number | 1265895569 |
|---|---|
| LBN Legal business name | Intown Pediatric Behavioral Wellness Llc |
| DBA Doing business as | |
| Authorized official | Poulos, Jennifer Lynn PSY.D. |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 4th, 2016 |
| Last updated | Apr 4th, 2016 - about 8 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265895569 | NPPES |
| Georgia | MEDICAID | 003139753A |
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