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General NPI Number Information
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NPI Number | 1457627044
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Entity Type | Organization
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Legal Business Name | ATHENS PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1090 FOUNDERS BLVD STE. B
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City | ATHENS
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State | GA
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Zip | 30606-6163
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Country | US
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Telephone | 706-548-8697
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Fax | 706-548-8698
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Provider Business Mailing Address
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Address Line | 1090 FOUNDERS BLVD STE. B
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City | ATHENS
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State | GA
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Zip | 30606-6163
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Country | US
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Telephone | 706-548-8697
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Fax | 706-548-8698
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSEPH E. MASON
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Credential |
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Telephone | 706-548-8697
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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 | PSY002674
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PSY002674
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY002674
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License Number State | GA
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