Provider Demographics
NPI:1265779904
Name:BEHAVIORAL MANAGEMENT GROUP, LLC
Entity type:Organization
Organization Name:BEHAVIORAL MANAGEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELONIE
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-686-3908
Mailing Address - Street 1:2795 MAIN ST W
Mailing Address - Street 2:BUILDING 19, SUITE B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3164
Mailing Address - Country:US
Mailing Address - Phone:770-686-3908
Mailing Address - Fax:770-674-7854
Practice Address - Street 1:2795 MAIN ST W
Practice Address - Street 2:BUILDING 19, SUITE B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3164
Practice Address - Country:US
Practice Address - Phone:770-686-3908
Practice Address - Fax:770-674-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002760103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty