Provider Demographics
NPI:1568091429
Name:KEYSTONE BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:KEYSTONE BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:ALTONETTE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CCTP, NCC
Authorized Official - Phone:470-701-0167
Mailing Address - Street 1:1100 PEACHTREE ST NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4829
Mailing Address - Country:US
Mailing Address - Phone:470-701-0167
Mailing Address - Fax:
Practice Address - Street 1:1100 PEACHTREE ST NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4829
Practice Address - Country:US
Practice Address - Phone:470-701-0167
Practice Address - Fax:470-280-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)