NPI 1003405275

Jonathan Lively, RBT

Practitioner Behavior Technician Marietta, GA

Practice location

Address: 2651 Dallas Hwy SW, Marietta, GA 30064-2541
Phone: (678) 486-1904
Fax: (317) 520-8200
Mailing address: 3500 Depauw Blvd STE 3070, Indianapolis, IN 46268-6135

Registered specialties

Behavior Technician Primary

Behavioral Health & Social Service Providers Taxonomy 106S00000X Licence RBT-21-151506 (GA)

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Registry record

NPI: 1003405275
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Jan 2021
Record last updated: 13 Jan 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.