=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669898961
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A-Z BEHAVIORAL SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2014
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 SCARBROUGH ST STE A
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39218-9770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-219-0090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 SCARBROUGH ST STE A
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39218-9770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | GARY ROBERSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 615-219-0090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 201885
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 15474
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------