Provider Demographics
NPI:1376394783
Name:OPERATION STREET HARVEST, INC.
Entity Type:Organization
Organization Name:OPERATION STREET HARVEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT/CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SUMNER BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC, CPCS
Authorized Official - Phone:678-978-9391
Mailing Address - Street 1:3982 MISTY LK
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1164
Mailing Address - Country:US
Mailing Address - Phone:678-978-9391
Mailing Address - Fax:
Practice Address - Street 1:1 W COURT SQ STE 750
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2538
Practice Address - Country:US
Practice Address - Phone:678-978-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty