| Blue Ridge Psychological Services, Llc | |
|
9757 Blue Ridge Dr Blue Ridge GA 30513-4167 | |
| (706) 455-2490 | |
| (706) 946-6574 |
| Full Name | Blue Ridge Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 9757 Blue Ridge Dr, Blue Ridge, Georgia |
| Authorized Official Name and Position | Kyle David Raque (REGISTERED AGENT/OWNER) |
| Authorized Official Contact | 7064552490 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Ridge Psychological Services, Llc 9757 Blue Ridge Dr Blue Ridge GA 30513-4167 Ph: (706) 455-2490 | Blue Ridge Psychological Services, Llc 9757 Blue Ridge Dr Blue Ridge GA 30513-4167 Ph: (706) 455-2490 |
| NPI Number | 1750524781 |
|---|---|
| Provider Enumeration Date | 04/06/2009 |
| Last Update Date | 02/26/2020 |
| Certification Date | 02/26/2020 |
| Medicare PECOS PAC ID | 1759428063 |
|---|---|
| Medicare Enrollment ID | O20091019000599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750524781 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003039 (Georgia) | Primary |
| Provider Name | Kyle D Raque |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790863900 PECOS PAC ID: 0345262481 Enrollment ID: I20070215000010 |
| Provider Name | Chinwe Ibiam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598289860 PECOS PAC ID: 3870846553 Enrollment ID: I20181025002847 |
| Provider Name | John Batkins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245434257 PECOS PAC ID: 9436491453 Enrollment ID: I20190805001733 |
| Provider Name | Lee Ann Brady Lehman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275849036 PECOS PAC ID: 1658642293 Enrollment ID: I20201211000962 |
| Provider Name | Brian Burke Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235796004 PECOS PAC ID: 3173920394 Enrollment ID: I20210930000301 |
| Provider Name | Benjamin Robert Crawford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215166871 PECOS PAC ID: 7113173980 Enrollment ID: I20220610000819 |
| Provider Name | Michael Newberry |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1467569889 PECOS PAC ID: 6507929981 Enrollment ID: I20230110003215 |
Riverstone Medical Campus Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 Riverstone Vis, Suite 101, Blue Ridge, GA 30513 Phone: 706-632-4400 Fax: 706-632-4404 | |
Mineral Springs Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 35 Circle Dr, Blue Ridge, GA 30513 Phone: 706-632-2094 Fax: 706-632-6587 | |
Highland Rivers Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 395 April Ln, Blue Ridge, GA 30513 Phone: 706-270-5033 Fax: 706-370-7749 | |
Linda M. Silva, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 460 W Main St, Suite 101, Blue Ridge, GA 30513 Phone: 706-633-8145 Fax: 706-946-6574 | |
Natural Healing Concepts Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 40 Highland Cir, Blue Ridge, GA 30513 Phone: 706-258-3219 Fax: 706-258-3219 | |
Blue Ridge Psychiatric Consultants Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 990 E Main St, Blue Ridge, GA 30513 Phone: 706-258-2192 Fax: 706-258-2193 | |
Susan K Kauffman Lmhc Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 146 Depot St Ste 202, Blue Ridge, GA 30513 Phone: 941-780-4192 |