MEDICARE: LIONROCK BEHAVIORAL HEALTH, INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1982171856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIONROCK BEHAVIORAL HEALTH, INC

Provider Business Mailing Address
First Line	:	911 LAKEVILLE ST # 322
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3329
Country	:	US
Telephone Number	:	760-994-4990
Fax Number	:

Provider Business Practice Location Address
First Line	:	3348 PEACHTREE RD NE STE 700
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1442
Country	:	US
Telephone Number	:	760-994-4990
Fax Number	:	866-899-8670

Authorized Official
Title or Position	:	COO/SECRETARY/ADMINISTRATION
Name	:	IAIN CRABB
Credential	:
Telephone Number	:	760-994-4990

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	11/07/2018

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