Provider Demographics
NPI:1366240202
Name:FAVORS BEHAVIORAL HEALTH & CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:FAVORS BEHAVIORAL HEALTH & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVORS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:678-215-4907
Mailing Address - Street 1:1575 LAWRENCEVILLE HWY STE K
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2007
Mailing Address - Country:US
Mailing Address - Phone:678-215-4907
Mailing Address - Fax:678-671-8489
Practice Address - Street 1:1575 LAWRENCEVILLE HWY STE K
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2007
Practice Address - Country:US
Practice Address - Phone:678-215-4907
Practice Address - Fax:678-671-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty