=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992207989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANDPOINT THERAPY & ORGANIZATIONAL CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2018
-----------------------------------------------------
Last Update Date | 03/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2773 BEN HILL RD
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30344-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-453-8749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2773 BEN HILL RD
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30344-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | BRANDEIS GREEN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 678-571-3479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PSY003857
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------