MEDICARE: ORGANIC THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		GA

General Provider Information

NPI Number	:	1013360379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORGANIC THERAPY

Provider Business Mailing Address
First Line	:	3450 JONES MILL ROAD
Second Line	:	315
City	:	NORCROSS
State	:	GA
Zip	:	30092
Country	:	US
Telephone Number	:	678-923-0740
Fax Number	:

Provider Business Practice Location Address
First Line	:	5283 BELLS FERRY RD
Second Line	:	STE120
City	:	ACWORTH
State	:	GA
Zip	:	30102-2500
Country	:	US
Telephone Number	:	678-923-0740
Fax Number	:	770-393-6439

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MISS PATRICIA CHRISTINA THOMPSON
Credential	:	MACC
Telephone Number	:	678-923-0740

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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