Provider Demographics
NPI:1912365677
Name:FORSYTH INTERVENTION SERVICES AND TRAINING
Entity Type:Organization
Organization Name:FORSYTH INTERVENTION SERVICES AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BERT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-236-3478
Mailing Address - Street 1:32 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-1839
Mailing Address - Country:US
Mailing Address - Phone:470-236-3478
Mailing Address - Fax:
Practice Address - Street 1:32 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-1839
Practice Address - Country:US
Practice Address - Phone:470-236-3478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008838101YA0400X, 101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty