Provider Demographics
NPI:1326601006
Name:PUZZLE PALACE MENTAL AND BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PUZZLE PALACE MENTAL AND BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:PUZZLE PALACE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIOUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-771-8543
Mailing Address - Street 1:3277 SUMMIT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5398
Mailing Address - Country:US
Mailing Address - Phone:404-771-8543
Mailing Address - Fax:404-965-5009
Practice Address - Street 1:3277 SUMMIT GLEN DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5398
Practice Address - Country:US
Practice Address - Phone:404-771-8543
Practice Address - Fax:404-965-5009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ELITE NETWORK CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-17
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty