Provider Demographics
NPI:1457520660
Name:MTBM GLOBAL REHABILITATION
Entity Type:Organization
Organization Name:MTBM GLOBAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SILVIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-987-7414
Mailing Address - Street 1:2890A GA HWY 212
Mailing Address - Street 2:SUITE 239
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094
Mailing Address - Country:US
Mailing Address - Phone:770-987-7414
Mailing Address - Fax:770-987-3106
Practice Address - Street 1:2890A GA HWY 212
Practice Address - Street 2:SUITE 239
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:770-987-7414
Practice Address - Fax:770-987-3106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MTBM GLOBAL REHABILITATION CONSULTANTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-22
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4592101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty