NPIMap

Organization Active NPI

Footprints Psychological Services LLC

  • Clinical Psychologist
  • Athens, GA
National Provider Identifier
1487904454
Registry record updated Sep 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY003585 Issued in GA
Legal business name
FOOTPRINTS PSYCHOLOGICAL SERVICES LLC
Practice address
1090 Founders Blvd.
Ste B
Athens, GA 30606
Phone
(706) 548-8697
Fax
(706) 548-8698
NPI assigned
Sep 17, 2012
Last updated
Sep 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2012

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

Authorized official

Name
Ms. Carolyn Patricia Barnes, PSY.D.NPI 1689920167
Title
Manager/Licensed Clinical Psycholog
Phone
(706) 548-8697

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY003585 GA Primary

Addresses

Primary practice location

1090 Founders Blvd.
Ste B
Athens, GA 30606

Mailing address

1090 Founders Blvd.
Ste B
Athens, GA 30606
Phone (706) 548-8697

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1487904454",
    "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": "30606",
            "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": "30606",
            "telephone_number": "706-548-8697",
            "fax_number": "706-548-8698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTPRINTS PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "MANAGER/LICENSED CLINICAL PSYCHOLOG",
        "authorized_official_telephone_number": "706-548-8697",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.