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General NPI Number Information
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NPI Number | 1568091429
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Entity Type | Organization
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Legal Business Name | KEYSTONE BEHAVIORAL HEALTH CENTER
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 1100 PEACHTREE ST NE STE 200
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City | ATLANTA
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State | GA
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Zip | 30309-4829
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Country | US
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Telephone | 470-701-0167
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Fax | 470-280-9441
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Provider Business Mailing Address
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Address Line | 1100 PEACHTREE ST NE STE 200
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City | ATLANTA
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State | GA
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Zip | 30309-4829
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Country | US
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Telephone | 470-701-0167
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MAYA ALTONETTE BUTLER
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Credential | LPC, CCTP, NCC
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Telephone | 470-701-0167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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