Healthcare Provider Details

I. General information

NPI: 1548411101
Provider Name (Legal Business Name): TRINITY PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9635 VENTANA WAY SUITE 101
JOHNS CREEK GA
30022-8261
US

IV. Provider business mailing address

9635 VENTANA WAY SUITE 101
JOHNS CREEK GA
30022-8261
US

V. Phone/Fax

Practice location:
  • Phone: 678-366-8862
  • Fax: 678-739-0119
Mailing address:
  • Phone: 678-366-8862
  • Fax: 678-739-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002798
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY0002798
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY0002798
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY0002798
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY0002798
License Number StateGA

VIII. Authorized Official

Name: DR. ROBERT MONTES
Title or Position: OWNER/OPERATOR
Credential: PHD
Phone: 678-366-8862