Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY3966 | FL |
Y | 103TC0700X | Clinical Psychologist | PY3966 | FL |
NPI | 1003984832 |
---|---|
Provider Name | Dr. Emily Jane Futch |
First Address | Pinellas Park, FL 33781-4350 |
Second Address | Pinellas Park, FL 33781-4350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |