Provider Demographics
NPI:1730936840
Name:BEHAVIORAL KINETICS
Entity type:Organization
Organization Name:BEHAVIORAL KINETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-376-9999
Mailing Address - Street 1:905 ROCKY RIDGE PASS
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9751
Mailing Address - Country:US
Mailing Address - Phone:770-376-9999
Mailing Address - Fax:
Practice Address - Street 1:125 TOWNPARK DR NW STE 300
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3231
Practice Address - Country:US
Practice Address - Phone:470-295-5682
Practice Address - Fax:888-791-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty