Healthcare Provider Details

I. General information

NPI: 1891517595
Provider Name (Legal Business Name): BEYOND BORDERS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 GLENRIDGE DR STE 230
SANDY SPRINGS GA
30328-9929
US

IV. Provider business mailing address

5887 GLENRIDGE DR STE 230
SANDY SPRINGS GA
30328-9929
US

V. Phone/Fax

Practice location:
  • Phone: 504-756-6797
  • Fax:
Mailing address:
  • Phone: 504-756-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRYON NGUYEN
Title or Position: CERTIFIED CLINICAL HYPNOTHERAPIST
Credential: CCHT
Phone: 504-756-6797