Provider Demographics
NPI:1144968322
Name:IDEAL MINDS BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:IDEAL MINDS BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-974-0342
Mailing Address - Street 1:2090 LAWRENCEVILLE SUWANEE RD # 747
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2600
Mailing Address - Country:US
Mailing Address - Phone:678-974-0342
Mailing Address - Fax:
Practice Address - Street 1:2090 LAWRENCEVILLE SUWANEE RD # 747
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2600
Practice Address - Country:US
Practice Address - Phone:678-974-0342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health