Provider Demographics
NPI:1013147743
Name:NEUROPSYCHOLOGICAL TESTING AND COUNSELING
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGICAL TESTING AND COUNSELING
Other - Org Name:ELIZABETH M. SOETY, PH.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOETY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:478-953-0088
Mailing Address - Street 1:102 GUNN RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1706
Mailing Address - Country:US
Mailing Address - Phone:478-953-0088
Mailing Address - Fax:478-953-0093
Practice Address - Street 1:102 GUNN RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028
Practice Address - Country:US
Practice Address - Phone:478-953-0088
Practice Address - Fax:478-953-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2815103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGKCMedicare PIN