MEDICARE: ACCESS MENTAL HEALTH AGENCY

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	101YP2500X	Professional Counselor	005397	GA
2	101YP2500X	Professional Counselor	006044	GA
3	101YP2500X	Professional Counselor	006188	GA
4	101YP2500X	Professional Counselor	006400	GA
5	101YP2500X	Professional Counselor	006760	GA
6	101YP2500X	Professional Counselor	006205	GA
7	103TP0016X	Prescribing (Medical) Psychologist	046882	GA
8	103TP0016X	Prescribing (Medical) Psychologist	10576464	GA
9	101YP2500X	Professional Counselor	005536	GA

General Provider Information

NPI Number	:	1023431210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS MENTAL HEALTH AGENCY

Provider Business Mailing Address
First Line	:	215 LAKEWOOD WAY SW
Second Line	:	205
City	:	ATLANTA
State	:	GA
Zip	:	30315-6022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 LAKEWOOD WAY SW
Second Line	:	205
City	:	ATLANTA
State	:	GA
Zip	:	30315-6022
Country	:	US
Telephone Number	:	678-335-9010
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RODERICK BROWN
Credential	:
Telephone Number	:	678-335-9010

Provider Enumeration Date	:	01/24/2014
Last Update Date	:	01/24/2014

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Directions to “ACCESS MENTAL HEALTH AGENCY ” Practice Location

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