Denella Lazenby Ausborn, PSY.D.
Individual provider Active NPI Clinical Psychologist · Tucker, GA
NPI 1174676563 · NPPES record last updated Sep 2, 2009
Key facts
- NPI
- 1174676563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2469 (GA)
- Practice address
- 4500 Hugh Howell Rd
Suite 740
Tucker, GA 30084-4723 - Phone
- (770) 938-4616
- Fax
- (770) 938-4615
- NPI assigned
- Jan 19, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2469 | GA | MD | Anesthesiologist Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ausborn Behavioral Care, PC | Clinical | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2469 | GA | Yes |
Addresses
Primary practice location
4500 Hugh Howell Rd
Suite 740
Tucker, GA 30084-4723
Mailing address
4500 Hugh Howell Rd
Suite 740
Tucker, GA 30084-4723
Phone (770) 938-4616
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01000297 | Other | GA | AMERIGROUP |
| 2678878 | Other | GA | MAGELLAN |
| 33-1078488 | Other | GA | NORTHLAKE MEDICAL RESEARC |
| 6134630 | Other | GA | UNITED BEHAVIORAL HEALTH |
| 279069000 | Other | GA | MAGELLAN |
| 00891151A | Medicaid | GA | |
| 2441599995-02 | Other | GA | MAGELLAN |
| 2441599995-02 | Other | GA | UNITED BEHAVIORAL HEALTH |
| 001346 | Other | GA | BLUECROSS BLUESHIELD OF G |
| 7066282 | Other | GA | AETNA, EL PASO |
| 744015 | Other | GA | AETNA |
| 744015 | Other | GA | AETNA, LEXINGTON |
Other providers in Tucker, GA
- Atlanta Priority Care LLC
- Atlanta Vascular Research Foundation
- Attachment & Bonding Center of Atlanta, LLC
- Attachment and Bonding Center of Atlanta, LLC
- Audiology Services Company USA, LLC
- Willie F Ausborn
- Jennifer Lauren Austin
- Kimberly Averett
- Avondale Health Services, Inc
- Avondale Health Services, Inc.
All providers in Tucker, GA · Clinical Psychologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.