Healthcare Provider Details

I. General information

NPI: 1326601006
Provider Name (Legal Business Name): PUZZLE PALACE MENTAL AND BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/09/2023
Certification Date: 04/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 SUMMIT GLEN DR
LOGANVILLE GA
30052-5398
US

IV. Provider business mailing address

3277 SUMMIT GLEN DR
LOGANVILLE GA
30052-5398
US

V. Phone/Fax

Practice location:
  • Phone: 404-771-8543
  • Fax: 404-965-5009
Mailing address:
  • Phone: 404-771-8543
  • Fax: 404-965-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: BRIOUNA RICHARDS
Title or Position: OWNER
Credential:
Phone: 404-771-8543