MEDICARE: ALLIANT BEHAVIORAL HEALTH LLC

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	003136558A	GA
2	305R00000X	Preferred Provider Organization	003136558A	GA
3	343900000X	Non-emergency Medical Transport (VAN)	003136558A	GA
4	251S00000X	Community/Behavioral Health Agency	LPC4527	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326455619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANT BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	5283 BELLS FERRY RD
Second Line	:	STE 120
City	:	ACWORTH
State	:	GA
Zip	:	30102-2500
Country	:	US
Telephone Number	:	770-240-0932
Fax Number	:	770-393-6439

Provider Business Practice Location Address
First Line	:	5283 BELLS FERRY RD
Second Line	:	STE 120
City	:	ACWORTH
State	:	GA
Zip	:	30102-2500
Country	:	US
Telephone Number	:	678-393-6439
Fax Number	:	404-393-6439

Authorized Official
Title or Position	:	CEO
Name	:	MS. YOLANDA SEALS
Credential	:	LPC, LMFT
Telephone Number	:	404-663-8012

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	01/21/2016

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Directions to “ALLIANT BEHAVIORAL HEALTH LLC ” Practice Location

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