Provider Demographics
NPI:1336639582
Name:KIDS ZONE BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:KIDS ZONE BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:LYNDSEY
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:706-887-5787
Mailing Address - Street 1:321 B GREENVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241
Mailing Address - Country:US
Mailing Address - Phone:706-887-5787
Mailing Address - Fax:706-780-5402
Practice Address - Street 1:321 B GREENVILLE STREET
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241
Practice Address - Country:US
Practice Address - Phone:706-887-5787
Practice Address - Fax:706-780-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GAMFT001596261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003205328AMedicaid