| Behavioral Health Professionals Of Lagrange, Llc | |
|
321b Greenville St Lagrange GA 30241-3231 | |
| (706) 616-1715 | |
| (706) 637-2320 |
| Full Name | Behavioral Health Professionals Of Lagrange, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 321b Greenville St, Lagrange, Georgia |
| Authorized Official Name and Position | Nicholas Moses (OWNER) |
| Authorized Official Contact | 7066161715 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Health Professionals Of Lagrange, Llc 321b Greenville St Lagrange GA 30241-3231 Ph: (706) 616-1715 | Behavioral Health Professionals Of Lagrange, Llc 321b Greenville St Lagrange GA 30241-3231 Ph: (706) 616-1715 |
| NPI Number | 1861016537 |
|---|---|
| Provider Enumeration Date | 05/29/2020 |
| Last Update Date | 07/27/2023 |
| Certification Date | 07/27/2023 |
| Medicare PECOS PAC ID | 3779982079 |
|---|---|
| Medicare Enrollment ID | O20210518002170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861016537 | NPI | - | NPPES |
| Provider Name | Linda A Vrooman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841627775 PECOS PAC ID: 2769616408 Enrollment ID: I20131011000122 |
| Provider Name | Lauren E Hornsby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972932036 PECOS PAC ID: 9739405747 Enrollment ID: I20150311000695 |
| Provider Name | Elaine N Shirah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326590282 PECOS PAC ID: 6103104898 Enrollment ID: I20161101000513 |
| Provider Name | Tara Fountain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356895353 PECOS PAC ID: 8022350156 Enrollment ID: I20190422000153 |
| Provider Name | Brandy Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730747593 PECOS PAC ID: 2668704834 Enrollment ID: I20191022000865 |
| Provider Name | Annthony Michael Duffey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063992154 PECOS PAC ID: 4688021587 Enrollment ID: I20231115000833 |
| Provider Name | Jordan Lyndsey Child |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1558753889 PECOS PAC ID: 6800239880 Enrollment ID: I20240206004532 |
| Provider Name | Stuart Paul Davis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811043540 PECOS PAC ID: 4284826116 Enrollment ID: I20240429001072 |
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