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General NPI Number Information
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NPI Number | 1376343699
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Entity Type | Organization
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Legal Business Name | BLUE EPIPHANIES
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1686 DUNTON GREEN WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7531
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Country | US
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Telephone | 470-207-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 1686 DUNTON GREEN WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7531
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Country | US
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Telephone | 470-207-2410
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST, OWNER
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Name | DR. BRANDON LANDRY
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Credential | PSY.D.
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Telephone | 470-207-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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