Provider Demographics
NPI:1386059251
Name:NEUROBEHAVIORAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:NEUROBEHAVIORAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HERTZA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-823-5266
Mailing Address - Street 1:207 HUDSON TRCE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2010
Mailing Address - Country:US
Mailing Address - Phone:706-823-5250
Mailing Address - Fax:706-823-5266
Practice Address - Street 1:207 HUDSON TRCE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2010
Practice Address - Country:US
Practice Address - Phone:706-823-5250
Practice Address - Fax:706-823-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X, 101Y00000X, 103T00000X, 103TC2200X, 103TC0700X
GAAPC004405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty