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General NPI Number Information
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NPI Number | 1184869299
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Entity Type | Organization
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Legal Business Name | FAMILY PSYCHOLOGY ASSOCIATES
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 516 RIDLEY AVE
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City | LAGRANGE
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State | GA
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Zip | 30240-2234
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Country | US
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Telephone | 706-845-1601
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Fax | 706-845-8510
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Provider Business Mailing Address
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Address Line | 516 RIDLEY AVE
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City | LAGRANGE
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State | GA
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Zip | 30240-2234
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Country | US
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Telephone | 706-845-1601
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Fax | 706-845-8510
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. KELLY BOLES MCKAY
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Credential |
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Telephone | 706-845-1601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY002670
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002848
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License Number State | GA
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