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General NPI Number Information
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NPI Number | 1326601006
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Entity Type | Organization
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Legal Business Name | PUZZLE PALACE MENTAL AND BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/09/2023
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Provider Practice Location Address
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Address Line | 3277 SUMMIT GLEN DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-5398
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Country | US
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Telephone | 404-771-8543
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Fax | 404-965-5009
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Provider Business Mailing Address
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Address Line | 3277 SUMMIT GLEN DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-5398
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Country | US
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Telephone | 404-771-8543
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Fax | 404-965-5009
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Authorized Official
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Title or Position | OWNER
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Name | BRIOUNA RICHARDS
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Credential |
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Telephone | 404-771-8543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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