Healthcare Provider Details

I. General information

NPI: 1336705961
Provider Name (Legal Business Name): BEHAVIORAL SCIENCE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3623 CALVIN DRIVE
COLUMBUS GA
31904-7915
US

IV. Provider business mailing address

3623 CALVIN DRIVE
COLUMBUS GA
31904-7915
US

V. Phone/Fax

Practice location:
  • Phone: 706-940-5100
  • Fax: 762-208-7512
Mailing address:
  • Phone: 706-940-5100
  • Fax: 762-208-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELLEY D WALLS
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 706-940-5100