Healthcare Provider Details

I. General information

NPI: 1700418142
Provider Name (Legal Business Name): BEHAVIOR THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4744 N ROYAL ATLANTA DR STE A
TUCKER GA
30084-3820
US

IV. Provider business mailing address

4744 N ROYAL ATLANTA DR STE A
TUCKER GA
30084-3820
US

V. Phone/Fax

Practice location:
  • Phone: 770-276-9156
  • Fax:
Mailing address:
  • Phone: 678-609-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHATRECE JENKINS
Title or Position: DIRECTOR
Credential: LSW
Phone: 770-276-9156