Southeast Psychological Services PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5021 Issued in NC

Legal business name

SOUTHEAST PSYCHOLOGICAL SERVICES PLLC

Practice address

8840 Blakeney Professional Dr
Suite 200
Charlotte, NC 28277-6718

Phone

(704) 552-0116

Fax

(704) 552-7550

NPI assigned

Apr 30, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Janet H Iyoob

Title

Cfo

Phone

(704) 552-0116

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Southeast Psychological Services, PLLC

  • Psychologist
  • Charlotte, NC
  • NPI 1811053218

  O20040731000305

  Same enrollment

Locations

Practitioners 1

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

• Jonathan B Feather, PSY.D.

  • Psychologist
  • Charlotte, NC
  • NPI 1538243514
  NPD

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

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1407090707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6115 PARK SOUTH DR",
            "address_2": "SUITE 130",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103269",
            "telephone_number": "704-552-0116",
            "fax_number": "704-552-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8840 BLAKENEY PROFESSIONAL DR",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776718",
            "telephone_number": "704-552-0116",
            "fax_number": "704-552-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-30",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "IYOOB",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "704-552-0116",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "5021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005111",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Anesthesiology Consultants, PLLC
• Southeast Bariatrics
• Southeast Family Care PLLC
• Southeast Pain Management Services, PLLC
• Southeast Pathology Consultants, Inc.
• Southeast Psychological Services, PLLC
• Southeast Radiation Oncology Group, P.a.
• Southeast Radiology Associates PLLC
• Southeast Renal Associates PA
• Southeast Surgical Specialists, PLLC

• Clinical Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; 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.