Provider Demographics
NPI:1225763162
Name:BEHAVIORAL LEARNED MANAGEMENT LLC
Entity Type:Organization
Organization Name:BEHAVIORAL LEARNED MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:DAMEON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:478-731-2087
Mailing Address - Street 1:620 NICHOLAS LN
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-7383
Mailing Address - Country:US
Mailing Address - Phone:478-731-2087
Mailing Address - Fax:
Practice Address - Street 1:620 NICHOLAS LN
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-7383
Practice Address - Country:US
Practice Address - Phone:478-731-2087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health