Provider Demographics
NPI:1083345680
Name:APPALACHIAN PSYCHOLOGICAL AND BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:APPALACHIAN PSYCHOLOGICAL AND BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:802-404-2727
Mailing Address - Street 1:230 WILD IRIS LN
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-1814
Mailing Address - Country:US
Mailing Address - Phone:802-404-2727
Mailing Address - Fax:
Practice Address - Street 1:1423 WASHINGTON ST STE 212
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5422
Practice Address - Country:US
Practice Address - Phone:802-404-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003264607AMedicaid