Generative Therapy Center LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

GENERATIVE THERAPY CENTER LLC

Doing business as

Generative Therapy Center
Michel Bordeau LCSW

Practice address

968 Summit LN
Ellijay, GA 30540-8728

Phone

(646) 582-9774

NPI assigned

Sep 21, 2018

Last updated

May 17, 2019By 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

Michel Bordeau, LCSWNPI 1215324397

Title

Owner

Phone

(646) 582-9774

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• GENERATIVE THERAPY CENTER Doing business as
• MICHEL BORDEAU LCSW Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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.

• Michel Bordeau, MA, LCSW

  • Clinical Social Worker
  • Ellijay, GA
  • NPI 1215324397
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1537488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558051200000",
    "number": "1861976144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "968 SUMMIT LN # 1042",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305408728",
            "telephone_number": "646-582-9774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "968 SUMMIT LN",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305408728",
            "telephone_number": "646-582-9774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERATIVE THERAPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-21",
        "last_updated": "2019-05-17",
        "status": "A",
        "authorized_official_last_name": "BORDEAU",
        "authorized_official_first_name": "MICHEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-582-9774",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "CSW006489",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GENERATIVE THERAPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GENERATIVE THERAPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MICHEL BORDEAU LCSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Ellijay, GA
• Providers in Ellijay, 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 May 17, 2019; 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.