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NPI Code Detail

MEDICARE: NEUROBEHAVIORAL ASSOCIATES, LLC

MEDICARE: NEUROBEHAVIORAL ASSOCIATES, 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
1101Y00000XCounselor
2101YM0800XMental Health CounselorAPC004405GA
3103TC1900XCounseling Psychologist
4103TC2200XClinical Child & Adolescent Psychologist
5103T00000XPsychologist
6103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1386059251
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROBEHAVIORAL ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 207 HUDSON TRCE
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2010
Country : US
Telephone Number : 706-823-5250
Fax Number : 706-823-5266
Provider Business Practice Location Address
First Line : 207 HUDSON TRCE
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2010
Country : US
Telephone Number : 706-823-5250
Fax Number : 706-823-5266
Authorized Official
Title or Position : EXEC CLINICAL DIRECTOR
Name : MR. JEREMY B HERTZA
Credential : PSYD
Telephone Number : 706-823-5266
Provider Enumeration Date : 06/30/2014
Last Update Date : 05/19/2026

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