Athens Psychological Services, LLC

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PSY002674 Issued in GA

Legal business name

ATHENS PSYCHOLOGICAL SERVICES, LLC

Practice address

1090 Founders Blvd
Ste. B
Athens, GA 30606-6163

Phone

(706) 548-8697

Fax

(706) 548-8698

NPI assigned

Mar 28, 2012

Last updated

Mar 28, 2012By 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

Mr. Joseph E. Mason

Title

Ceo

Phone

(706) 548-8697

Specialties & licenses 3

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332892800000",
    "number": "1457627044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 FOUNDERS BLVD",
            "address_2": "STE. B",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066163",
            "telephone_number": "706-548-8697",
            "fax_number": "706-548-8698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 FOUNDERS BLVD",
            "address_2": "STE. B",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066163",
            "telephone_number": "706-548-8697",
            "fax_number": "706-548-8698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENS PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-28",
        "last_updated": "2012-03-28",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-548-8697",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY002674",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "GA",
            "license": "PSY002674",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "PSY002674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050836150C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10034544",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "556185000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in Athens, GA
• Providers in Athens, GA by specialty
• Clinical Child & Adolescent Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; 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.