Healthcare Provider Details

I. General information

NPI: 1053023515
Provider Name (Legal Business Name): MOZHGAN BAYATPOUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 POWERS FERRY RD SE
ATLANTA GA
30339-5620
US

IV. Provider business mailing address

1899 POWERS FERRY RD SE
ATLANTA GA
30339-5620
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8100
  • Fax:
Mailing address:
  • Phone: 770-389-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013745
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC007016
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: