Southeastern Behavioral Health and Consulting

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

SOUTHEASTERN BEHAVIORAL HEALTH AND CONSULTING

Practice address

53 Poplar St
Newnan, GA 30263-1039

Phone

(404) 516-1996

NPI assigned

Jul 18, 2019

Organization subpart

No

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

Authorized official

Name

Michelle Mitchell

Title

Chief Managing Officer

Phone

(404) 516-1996

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1659924751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2997 COBB PKWY SE UNIT 725575",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311392703",
            "telephone_number": "404-516-1996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 POPLAR ST",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302631039",
            "telephone_number": "404-516-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN BEHAVIORAL HEALTH AND CONSULTING",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CHIEF MANAGING OFFICER",
        "authorized_official_telephone_number": "404-516-1996"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.