NPIMap

Organization Active NPI

Neuropsychological Testing and Counseling

  • Clinical Psychologist
  • Centerville, GA
National Provider Identifier
1013147743
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2815 Issued in GA
Legal business name
NEUROPSYCHOLOGICAL TESTING AND COUNSELING
Practice address
102 Gunn Rd
Centerville, GA 31028
Phone
(478) 953-0088
Fax
(478) 953-0093
NPI assigned
Jul 15, 2009
Last updated
Jul 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Elizabeth Marie Soety, PH.D.NPI 1407815491
Title
Clinical Psychologist
Phone
(478) 953-0088

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2815 GA
Clinical Psychologist 103TC0700X 2815 GA Primary

Addresses

Primary practice location

102 Gunn Rd
Centerville, GA 31028

Mailing address

102 Gunn Rd
Centerville, GA 31028-1706
Phone (478) 953-0088

Other names 1

  • Elizabeth M. Soety, Ph.D. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091014000471 GA Part B Supplier - Clinic/Group Practice 7517003007 Receives reassigned benefits from 1 practitioner
Practice locations: Centerville, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531267200000",
    "number": "1013147743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 GUNN RD",
            "city": "CENTERVILLE",
            "state": "GA",
            "postal_code": "310281706",
            "telephone_number": "478-953-0088",
            "fax_number": "478-953-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 GUNN RD",
            "city": "CENTERVILLE",
            "state": "GA",
            "postal_code": "31028",
            "telephone_number": "478-953-0088",
            "fax_number": "478-953-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROPSYCHOLOGICAL TESTING AND COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-15",
        "last_updated": "2018-07-11",
        "status": "A",
        "authorized_official_last_name": "SOETY",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "478-953-0088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "GA",
            "license": "2815",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "2815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elizabeth M. Soety, Ph.D.",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Elizabeth M. Soety, Ph.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Centerville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.