Family Psychology Associates

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY002848 Issued in GA

Legal business name

FAMILY PSYCHOLOGY ASSOCIATES

Practice address

516 Ridley Ave
Lagrange, GA 30240-2234

Phone

(706) 845-1601

Fax

(706) 845-8510

NPI assigned

Dec 4, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Kelly Boles McKay

Title

Manager

Phone

(706) 845-1601

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephani Lee Cornelison, PHD, LCSW

  • Clinical Social Worker
  • Lagrange, GA
  • NPI 1265519698
  NPD (past)
• Virginia L. Goetsch, PH.D.

  • Clinical Psychologist
  • Decatur, GA
  • NPI 1962523456
  NPD (past)
• Andrew Barry Goff, PH.D.

  • Clinical Psychologist
  • Greensboro, NC
  • NPI 1306839998
  NPD (past)
• Linda Joan Goff, PHD

  • Clinical Psychologist
  • Greensboro, NC
  • NPI 1659535144
  NPD (past)
• Jeremy Sean McKay, PH.D

  • Clinical Psychologist
  • Chillicothe, OH
  • NPI 1043397474
  NPD (past)

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

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228348800000",
    "number": "1184869299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402234",
            "telephone_number": "706-845-1601",
            "fax_number": "706-845-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402234",
            "telephone_number": "706-845-1601",
            "fax_number": "706-845-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PSYCHOLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-04",
        "last_updated": "2008-12-04",
        "status": "A",
        "authorized_official_last_name": "MCKAY",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "BOLES",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "706-845-1601",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY002670",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY002848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688606375A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281868610A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Neal Erchak, M.D.
• Joseph Erickson, DDS
• Evolve Surgical Associates LLC
• Kathleen Ruth Fadler, DMD
• David Keith Fagundes, D.M.D.
• Fred Matthew Farrar, LPC , NCC
• Arthur James Fegain, MHP
• Snavly Fenelon
• Meagan Ferguson Daniels, NCC
• Aniqua Ferguson

• Clinical Psychologist in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.