Peachtree Psychology

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

003161 Issued in GA

Legal business name

PEACHTREE PSYCHOLOGY

Practice address

555 Sun Valley Dr
P4
Roswell, GA 30076-5612

Phone

(678) 381-1687

NPI assigned

Jul 21, 2016

Last updated

Jul 21, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan Keenan

Title

LPC

Phone

(617) 206-3976

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lynn Lane

  • Clinical Social Worker
  • Atlanta, GA
  • NPI 1104183847
  Medicare reassignment NPD

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469059200000",
    "number": "1467805747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 SUN VALLEY DR",
            "address_2": "P4",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765612",
            "telephone_number": "678-381-1687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 SUN VALLEY DR",
            "address_2": "P4",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765612",
            "telephone_number": "678-381-1687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE PSYCHOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-21",
        "last_updated": "2016-07-21",
        "status": "A",
        "authorized_official_last_name": "KEENAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "LPC",
        "authorized_official_telephone_number": "617-206-3976"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "003161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "003161",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• PD Ortho LLC
• Peace of Mind Behavior Solutions (Kind behavior solutions)
• Peacecare Counseling
• Peachtree Endocrinology
• Peachtree Primary Care PC
• Laura Rivers Pearson, MD
• Sean Pearson, OTR/L
• Pediatric & Family Psychological Services, P.C.
• Pediatric Physicians, P.C.
• Pediatric Therapy Services

• Professional Counselor in Roswell, GA
• Providers in Roswell, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.