Healthcare Provider Details

I. General information

NPI: 1871635417
Provider Name (Legal Business Name): SEYMOUR SHAYE M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/18/2024
Certification Date: 02/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 KAY LN NE
ATLANTA GA
30306-2108
US

IV. Provider business mailing address

1506 KAY LN NE
ATLANTA GA
30306-2108
US

V. Phone/Fax

Practice location:
  • Phone: 678-595-6116
  • Fax: 404-891-3749
Mailing address:
  • Phone: 678-595-6116
  • Fax: 404-891-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1204
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number567
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1204
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: