Mir Behavioral Health LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY003079 Issued in GA

Legal business name

MIR BEHAVIORAL HEALTH LLC

Practice address

6886 Main St
Ste 215
Lithonia, GA 30058-4508

Phone

(404) 759-3444

NPI assigned

Sep 1, 2011

Organization subpart

No

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

Authorized official

Name

Madinah I Ralston, PHD

Title

Owner

Phone

(770) 759-3444

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314835200000",
    "number": "1629359807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 ROCKBRIDGE RD",
            "address_2": "STE 208-185",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6886 MAIN ST",
            "address_2": "STE 215",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300584508",
            "telephone_number": "404-759-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIR BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-01",
        "last_updated": "2011-09-01",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "MADINAH",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-759-3444",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127231218G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Lithonia, GA
• Providers in Lithonia, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; 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.