Provider Demographics
NPI:1720458276
Name:EMERALD BEHAVIORAL AND HYPNOSIS SERVICES
Entity Type:Organization
Organization Name:EMERALD BEHAVIORAL AND HYPNOSIS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:478-331-9624
Mailing Address - Street 1:212 W JACKSON ST
Mailing Address - Street 2:STE A
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-6100
Mailing Address - Country:US
Mailing Address - Phone:478-331-9624
Mailing Address - Fax:478-304-5234
Practice Address - Street 1:212 W JACKSON ST
Practice Address - Street 2:STE A
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6100
Practice Address - Country:US
Practice Address - Phone:478-331-9624
Practice Address - Fax:478-304-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty