Healthcare Provider Details

I. General information

NPI: 1922938737
Provider Name (Legal Business Name): ALTARA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 PEBBLE FARM CT
GRAYSON GA
30017-1556
US

IV. Provider business mailing address

2703 PEBBLE FARM CT
GRAYSON GA
30017-1556
US

V. Phone/Fax

Practice location:
  • Phone: 954-663-6016
  • Fax: 470-824-3311
Mailing address:
  • Phone: 954-663-6016
  • Fax: 470-824-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARISSA PERRIER
Title or Position: CO-OWNER
Credential: PMHNP-BC
Phone: 954-663-6016