MEDICARE: 31 STORIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3478	GA

General Provider Information

NPI Number	:	1588627111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	31 STORIES, LLC

Provider Business Mailing Address
First Line	:	3390 PEACHTREE RD NE
Second Line	:	SUITE 1102
City	:	ATLANTA
State	:	GA
Zip	:	30326-1157
Country	:	US
Telephone Number	:	404-467-8203
Fax Number	:	404-467-8138

Provider Business Practice Location Address
First Line	:	3390 PEACHTREE RD NE
Second Line	:	SUITE 1102
City	:	ATLANTA
State	:	GA
Zip	:	30326-1157
Country	:	US
Telephone Number	:	404-467-8203
Fax Number	:	404-467-8138

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DR. JODY ELLEN HOUSKER
Credential	:	PH.D.
Telephone Number	:	404-467-8203

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	03/31/2010

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