Modern Therapy

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MODERN THERAPY

Practice address

1210 Fountain Cove LN
Lawrenceville, GA 30043-3974

Phone

(513) 449-0445

Fax

(513) 672-9859

NPI assigned

Feb 10, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robyn J Kelly, MSW,LISW

Title

Owner

Phone

(513) 449-0445

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1043917909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 FOUNTAIN COVE LN",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300433974",
            "telephone_number": "513-449-0445",
            "fax_number": "513-672-9859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 FOUNTAIN COVE LN",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300433974",
            "telephone_number": "513-449-0445",
            "fax_number": "513-672-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-10",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-449-0445",
        "authorized_official_credential": "MSW,LISW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225280142",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Cardina Mobbs, FNP-BC
• Mobile Care Physicians Group PC
• Mobile Convenience
• Mobile Mini Clinic
• Joy Standridge Mock, LPC
• Haresh Modha, D.D.S.
• Andrea Peyton Moe, PA
• Melanie Michelle Moebes
• Tim Scott Moeckel, D.C.
• Mofazzal Suraiya LLC

• Community/Behavioral Health Agency in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.