NPIMap

Organization Active NPI

Brandi Tanner, PH.D., LLC

Doing business as Lightway Psychological Services

  • Clinical Psychologist
  • Brookhaven, GA
National Provider Identifier
1871000117
Registry record updated Jan 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
BRANDI TANNER, PH.D., LLC
Doing business as
Lightway Psychological Services
Practice address
2801 Buford Hwy NE Ste 503
Brookhaven, GA 30329-2137
Phone
(404) 491-1684
Fax
(844) 646-0336
NPI assigned
Jan 9, 2018
Last updated
Jan 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2018

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

Authorized official

Name
Brandi Tanner, PH.D.NPI 1649670985
Title
Owner
Phone
(404) 491-1684

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Clinical Psychologist 103TC0700X Primary
School Psychologist 103TS0200X

Addresses

Primary practice location

2801 Buford Hwy NE Ste 503
Brookhaven, GA 30329-2137

Mailing address

2801 Buford Hwy NE Ste 503
Brookhaven, GA 30329-2137
Phone (404) 491-1684

Other identifiers 1

IdentifierTypeStateIssuer
003151503CMedicaidGA

Other names 1

  • Lightway Psychological Services Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515456000000",
    "number": "1871000117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 BUFORD HWY NE STE 503",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303292137",
            "telephone_number": "404-491-1684",
            "fax_number": "844-646-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 BUFORD HWY NE STE 503",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303292137",
            "telephone_number": "404-491-1684",
            "fax_number": "844-646-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDI TANNER, PH.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-09",
        "last_updated": "2018-01-09",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-491-1684",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003151503C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lightway Psychological Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookhaven, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2018; 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.