INNOVATIVE THERAPY GROUP NPI 1154193142

NPI Information

  • NPI: 1154193142
  • Provider Name: INNOVATIVE THERAPY GROUP
  • Classification: Clinic/Center - 261QM0801X
  • Specialization: Mental Health (Including Community Mental Health Center)
  • Entity Type: Organization
  • CLIA Number: 11D2328192
  • Address: 690 THORNTON WAY STE A
    LITHIA SPRINGS, GA
    ZIP 30122
  • Phone: (678) 324-0654

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NPI Details

INNOVATIVE THERAPY GROUP is a mental health (including community mental health center) clinic center in Lithia Springs, GA. INNOVATIVE THERAPY GROUP NPI is 1154193142. The provider is registered as an organization entity type.

The provider's business location address is:

690 THORNTON WAY STE A
LITHIA SPRINGS, GA
ZIP 30122-614
Phone: (678) 324-0654
Fax: (678) 810-0841

The provider's authorized official is Juan Zermeno Desantos .
The authorized official title is Program Director and has the following contact phone number (404) 290-6786.

The CLIA number assigned to this NPI record is 11D2328192 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/24/2023 and was last updated on 10/24/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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