Heather Chelsey Futral, PSY.D.
Individual provider Active NPI Clinical Psychologist · Hoschton, GA
NPI 1487954384 · NPPES record last updated Jul 14, 2015
Key facts
- NPI
- 1487954384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY003418 (GA)
- Practice address
- 4073 Highway 53
Hoschton, GA 30548-2305 - Phone
- (770) 882-5884
- Fax
- (706) 658-0116
- NPI assigned
- Oct 25, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151014001892 | GA | Practitioner - Clinical Psychologist | 2769791706 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003418 | GA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Georgia Psychological Services LLC | Clinical | Current |
Accepting new patients |
Locations
4073 Highway 53
Hoschton, GA 30548
Phone (770) 882-5884
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY003418 | GA | Yes |
Addresses
Primary practice location
4073 Highway 53
Hoschton, GA 30548-2305
Mailing address
4073 Highway 53
Hoschton, GA 30548-2305
Phone (770) 882-5884
Other providers in Hoschton, GA
- Kassia Florentine
- Four Corners Primary Care Centers Inc
- Franklin Ezeoke
- Curtina Freeman Rahming
- Megan Jackson Thacker Fusco
- Katherine Lovin Gee
- Georgia CVS Pharmacy, L.L.C.
- Georgia Foot Care, Inc.
- Joshua James Ghavidel
- Karen Gildemeyer
All providers in Hoschton, GA · Clinical Psychologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.