Life Transformation Psychological Center, PC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY003783 Issued in GA

Legal business name

LIFE TRANSFORMATION PSYCHOLOGICAL CENTER, PC

Practice address

1755 N Brown Rd
Suite 200
Lawrenceville, GA 30043-8198

Phone

(706) 530-1504

Fax

(855) 420-6045

NPI assigned

Feb 3, 2015

Last updated

Feb 3, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Elizabeth L. Anderson, PSY.D.NPI 1619303385

Title

Licensed Clinical Psychologist

Phone

(706) 530-1504

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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.

• Elizabeth L Anderson, PSY.D.

  • Clinical Psychologist
  • Lawrenceville, GA
  • NPI 1619303385
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422921600000",
    "number": "1285024810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 HERRINGTON RD",
            "address_2": "SUITE C 186",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447217",
            "telephone_number": "706-530-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 N BROWN RD",
            "address_2": "SUITE 200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300438198",
            "telephone_number": "706-530-1504",
            "fax_number": "855-420-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE TRANSFORMATION PSYCHOLOGICAL CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-03",
        "last_updated": "2015-02-03",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "706-530-1504",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY003783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2015; 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.