| Ideal Minds Behavioral Services | |
|
2090 Lawrenceville Suwanee Rd # 747 Suwanee GA 30024-2600 | |
| (678) 974-0342 | |
| Not Available |
| Full Name | Ideal Minds Behavioral Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 2090 Lawrenceville Suwanee Rd # 747, Suwanee, Georgia |
| Authorized Official Name and Position | Mary Opara (CEO/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6789740342 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ideal Minds Behavioral Services 2090 Lawrenceville Suwanee Rd # 747 Suwanee GA 30024-2600 Ph: (678) 974-0342 | Ideal Minds Behavioral Services 2090 Lawrenceville Suwanee Rd # 747 Suwanee GA 30024-2600 Ph: (678) 974-0342 |
| NPI Number | 1144968322 |
|---|---|
| Provider Enumeration Date | 05/26/2022 |
| Last Update Date | 05/26/2022 |
| Certification Date | 05/26/2022 |
| Medicare PECOS PAC ID | 6608256086 |
|---|---|
| Medicare Enrollment ID | O20220630003184 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144968322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mary Opara |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1821494352 PECOS PAC ID: 9931420981 Enrollment ID: I20150603001181 |
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