Provider Demographics
NPI:1215500632
Name:BEHAVIORAL LEARNING NETWORK GEORGIA LLC
Entity type:Organization
Organization Name:BEHAVIORAL LEARNING NETWORK GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT, BCBAD
Authorized Official - Phone:310-933-4499
Mailing Address - Street 1:75 RICHARDSON ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2839
Mailing Address - Country:US
Mailing Address - Phone:310-933-4499
Mailing Address - Fax:310-933-4134
Practice Address - Street 1:75 RICHARDSON ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2839
Practice Address - Country:US
Practice Address - Phone:310-933-4499
Practice Address - Fax:310-933-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health