Provider Demographics
NPI:1154167401
Name:TORRES, LUIS MIGUEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:MIGUEL
Last Name:TORRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 COLONIAL WAY APT B
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5315
Mailing Address - Country:US
Mailing Address - Phone:470-680-2588
Mailing Address - Fax:
Practice Address - Street 1:3190 NORTHEAST EXPY NE STE 110
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-5323
Practice Address - Country:US
Practice Address - Phone:404-480-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician