Provider Demographics
NPI:1003984832
Name:FUTCH, EMILY JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JANE
Last Name:FUTCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046 73RD AVE
Mailing Address - Street 2:ECP, PA
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-4350
Mailing Address - Country:US
Mailing Address - Phone:727-541-5436
Mailing Address - Fax:727-541-5484
Practice Address - Street 1:5046 73RD AVE
Practice Address - Street 2:ECP, PA
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4350
Practice Address - Country:US
Practice Address - Phone:727-541-5436
Practice Address - Fax:727-541-5484
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical