Healthcare Provider Details

I. General information

NPI: 1689485641
Provider Name (Legal Business Name): MENDA BEHAVIORAL HEALTH SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N CALHOUN ST STE 4
TALLAHASSEE FL
32301-1568
US

IV. Provider business mailing address

1303 PENDLETON ST SE
ATLANTA GA
30316-3801
US

V. Phone/Fax

Practice location:
  • Phone: 323-776-3632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: KARTIKEYA SHASTRI
Title or Position: FOUNDER
Credential:
Phone: 323-776-3632