Healthcare Provider Details

I. General information

NPI: 1669898961
Provider Name (Legal Business Name): A-Z BEHAVIORAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SCARBROUGH ST STE A
RICHLAND MS
39218-9770
US

IV. Provider business mailing address

120 SCARBROUGH ST STE A
RICHLAND MS
39218-9770
US

V. Phone/Fax

Practice location:
  • Phone: 615-219-0090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15474
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201885
License Number StateGA

VIII. Authorized Official

Name: GARY ROBERSON
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 615-219-0090