Phoenix Behavioral Health Service of Georgia

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC000247 Issued in GA

Legal business name

PHOENIX BEHAVIORAL HEALTH SERVICE OF GEORGIA

Practice address

8712 Tara Blvd
Jonesboro, GA 30236-4905

Phone

(770) 478-3417

Fax

(770) 478-3419

NPI assigned

Sep 24, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Nyla P Bowens, LPC

Title

Therapist/Professional Counselor

Phone

(770) 478-3417

Specialties & licenses 1

Addresses

Tax ID family

Phoenix Behavioral Ealth Services of Georgia2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Phoenix Behavioral Ealth Services of Georgia

  • Community/Behavioral Health Agency
  • Jonesboro, GA
  • NPI 1376600163
  NPD tax ID

Locations

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190592000000",
    "number": "1629264627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8712 TARA BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302364905",
            "telephone_number": "770-478-3417",
            "fax_number": "770-478-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8712 TARA BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302364905",
            "telephone_number": "770-478-3417",
            "fax_number": "770-478-3419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX BEHAVIORAL HEALTH SERVICE OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A",
        "authorized_official_last_name": "BOWENS",
        "authorized_official_first_name": "NYLA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "THERAPIST/PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "770-478-3417",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC000247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Yvonne Philadelphia, OT
• Melissa Philippe
• Amaria B Phillips, MSW
• Bonnie K. Phillips, D.C.
• Phoenix Behavioral Ealth Services of Georgia
• Phoenix Behavioral Health Services of Georgia, LLC
• Wasana J Phouangmalay, CST, CSFA
• Physiotherapy Associates Inc
• Luis Enrique Pierantoni Muniz, DC
• Richard Howard Pike, MD

• Community/Behavioral Health Agency in Jonesboro, GA
• Providers in Jonesboro, 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 Sep 24, 2007; 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.