Provider Demographics
NPI:1619125655
Name:INTOWN PSYCHOLOGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:INTOWN PSYCHOLOGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADM
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-474-7021
Mailing Address - Street 1:501 PULLIAM ST SW
Mailing Address - Street 2:STE 407
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2755
Mailing Address - Country:US
Mailing Address - Phone:404-474-7021
Mailing Address - Fax:404-592-4698
Practice Address - Street 1:501 PULLIAM ST SW
Practice Address - Street 2:STE 407
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2755
Practice Address - Country:US
Practice Address - Phone:404-474-7021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G701121OtherPTAN