Provider Demographics
NPI:1700686250
Name:NOUVEAUX U BEHAVIORAL HEALTH PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NOUVEAUX U BEHAVIORAL HEALTH PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULINE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:908-400-5058
Mailing Address - Street 1:2675 MALL OF GEORGIA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8783
Mailing Address - Country:US
Mailing Address - Phone:678-979-3905
Mailing Address - Fax:
Practice Address - Street 1:2675 MALL OF GEORGIA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8783
Practice Address - Country:US
Practice Address - Phone:678-979-3905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health