Healthcare Provider Details

I. General information

NPI: 1629842158
Provider Name (Legal Business Name): PARTNERS IN THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 CLIFTWOOD DR STE C
ATLANTA GA
30328-4917
US

IV. Provider business mailing address

27555 YNEZ RD. SUITE 110 UNIT 22
TEMECULA CA
92591
US

V. Phone/Fax

Practice location:
  • Phone: 404-225-1105
  • Fax: 951-294-5046
Mailing address:
  • Phone: 404-225-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY WILLIAMS
Title or Position: CLINICAL SUPERVISOR
Credential:
Phone: 404-225-1105