Healthcare Provider Details

I. General information

NPI: 1700300795
Provider Name (Legal Business Name): NYMPHA J. MATHURIN MEADOWS M.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 LAKEFIELD DR STE 200
JOHNS CREEK GA
30097-2456
US

IV. Provider business mailing address

2100 RIVERSIDE PKWY SUITE 128 - 144
LAWRENCEVILLE GA
30043-5368
US

V. Phone/Fax

Practice location:
  • Phone: 800-331-8604
  • Fax: 800-331-8604
Mailing address:
  • Phone: 800-331-8604
  • Fax: 800-331-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: