Southeast Psychological Consulting, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY5139 Issued in FL

Legal business name

SOUTHEAST PSYCHOLOGICAL CONSULTING, LLC

Practice address

4723B NW 53Rd Ave, Suite B
Southeast Psychological Consulting LLC
Gainesville, FL 32653

Phone

(352) 338-0077

Fax

(352) 372-6910

NPI assigned

Apr 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Helen Elizabeth Cadiz, PH.D, PSYCHOLOGIST

Title

PHD Licensed Psychologist/Owner

Phone

(352) 338-0077

Specialties & licenses 8

Addresses

Locations

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1710942347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 NW 43RD ST., SUITE 102 #254",
            "address_2": "SOUTHEAST PSYCHOLOGICAL CONSULTING LLC",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326064486",
            "telephone_number": "352-338-0077",
            "fax_number": "352-372-6910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4723B NW 53RD AVE, SUITE B",
            "address_2": "SOUTHEAST PSYCHOLOGICAL CONSULTING LLC",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "32653",
            "telephone_number": "352-338-0077",
            "fax_number": "352-372-6910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST PSYCHOLOGICAL CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "CADIZ",
        "authorized_official_first_name": "HELEN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PHD LICENSED PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "352-338-0077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D, PSYCHOLOGIST"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5139",
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "PY5139",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TE1100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Exercise & Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Psychoanalysis",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.