Provider Demographics
NPI:1902399686
Name:BLUEPRINT THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:BLUEPRINT THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:470-332-0605
Mailing Address - Street 1:275 13TH ST NE APT 310
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3698
Mailing Address - Country:US
Mailing Address - Phone:770-367-5270
Mailing Address - Fax:
Practice Address - Street 1:315 W PONCE DE LEON AVE STE 645
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2480
Practice Address - Country:US
Practice Address - Phone:470-332-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health