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General NPI Number Information
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NPI Number | 1801566047
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Entity Type | Organization
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Legal Business Name | MOMENTUM BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 09/19/2021
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Last Update Date | 09/19/2021
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Provider Practice Location Address
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Address Line | 132 GOLDEN SOUTH PKWY
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City | DALLAS
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State | GA
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Zip | 30157-1252
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Country | US
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Telephone | 404-290-3422
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Fax | 678-303-0347
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Provider Business Mailing Address
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Address Line | 831 GOVERNMENT FARM RD
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City | ROCKMART
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State | GA
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Zip | 30153-4419
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Country | US
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Telephone | 404-290-3422
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Fax | 678-303-0347
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Authorized Official
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Title or Position | CEO
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Name | KATELYN BUTLER
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Credential | MS, BCBA
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Telephone | 404-290-3422
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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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