Provider Demographics
NPI:1114639333
Name:RESPECT BEHAVIOR THERAPY
Entity Type:Organization
Organization Name:RESPECT BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:943-200-0016
Mailing Address - Street 1:4868 GA HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2473
Mailing Address - Country:US
Mailing Address - Phone:943-200-0016
Mailing Address - Fax:
Practice Address - Street 1:4868 GA HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2473
Practice Address - Country:US
Practice Address - Phone:943-200-0016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESPECT BEHAVIOR THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-19
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No385H00000XRespite Care FacilityRespite Care