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General NPI Number Information
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NPI Number | 1578437216
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Entity Type | Organization
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Legal Business Name | BEVIAN ENTERPRISE, LLC
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Dates
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Enumeration Date | 10/04/2025
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 2570 BENT CREEK DR
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City | CUMMING
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State | GA
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Zip | 30041-6366
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Country | US
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Telephone | 770-361-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 2570 BENT CREEK DR
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City | CUMMING
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State | GA
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Zip | 30041-6366
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Country | US
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Telephone | 770-361-8333
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | MR. BRIAN KEITH BAKER
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Credential |
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Telephone | 770-361-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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