Provider Demographics
NPI:1740880061
Name:PLEDGER BEHAVIOR CONSULTING, LLC
Entity type:Organization
Organization Name:PLEDGER BEHAVIOR CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PLEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:706-506-2113
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:MENLO
Mailing Address - State:GA
Mailing Address - Zip Code:30731-0066
Mailing Address - Country:US
Mailing Address - Phone:706-506-2113
Mailing Address - Fax:
Practice Address - Street 1:7563 HIGHWAY 337
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-6101
Practice Address - Country:US
Practice Address - Phone:706-862-2310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003202635BMedicaid