NPIMap

Organization Active NPI

Pickett Psychological Services

  • Clinical Psychologist
  • Berkeley Lake, GA
National Provider Identifier
1710497672
Registry record updated Oct 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY0045145 Issued in NU
Legal business name
PICKETT PSYCHOLOGICAL SERVICES
Practice address
4530 S Berkeley Lake Rd Ste B
Berkeley Lake, GA 30071-1657
Phone
(770) 821-6309
Fax
(770) 446-5643
NPI assigned
Oct 5, 2017
Last updated
Oct 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2017

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

Authorized official

Name
Ashlee Pickett, PSYD
Title
Provider
Phone
(770) 821-6309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY0045145 NU Primary

Addresses

Primary practice location

4530 S Berkeley Lake Rd Ste B
Berkeley Lake, GA 30071-1657

Mailing address

4530 S Berkeley Lake Rd Ste B
Berkeley Lake, GA 30071-1657

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1507161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507161600000",
    "number": "1710497672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 S BERKELEY LAKE RD STE B",
            "city": "BERKELEY LAKE",
            "state": "GA",
            "postal_code": "300711657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 S BERKELEY LAKE RD STE B",
            "city": "BERKELEY LAKE",
            "state": "GA",
            "postal_code": "300711657",
            "telephone_number": "770-821-6309",
            "fax_number": "770-446-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PICKETT PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-05",
        "last_updated": "2017-10-05",
        "status": "A",
        "authorized_official_last_name": "PICKETT",
        "authorized_official_first_name": "ASHLEE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "770-821-6309",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": "PSY0045145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley Lake, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; 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.