Healthcare Provider Details

I. General information

NPI: 1700498979
Provider Name (Legal Business Name): OUTPATIENT BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 N POINT PKWY STE 256
ALPHARETTA GA
30022-1174
US

IV. Provider business mailing address

10304 SPOTSYLVANIA AVE STE 300
FREDERICKSBURG VA
22408-8605
US

V. Phone/Fax

Practice location:
  • Phone: 770-667-3877
  • Fax: 770-667-3879
Mailing address:
  • Phone: 540-710-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOYCE A. MONTES
Title or Position: GENERAL COUNSEL
Credential: J.D., C.H.C.
Phone: 540-710-6085