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General NPI Number Information
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NPI Number | 1205078532
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Entity Type | Organization
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Legal Business Name | MADE FOR KIDS, INC.
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 182 BEN BURTON CIR SUITE 100
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City | BOGART
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State | GA
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Zip | 30622-6847
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Country | US
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Telephone | 706-995-3160
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Fax | 706-243-4611
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Provider Business Mailing Address
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Address Line | 182 BEN BURTON CIR SUITE 100
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City | BOGART
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State | GA
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Zip | 30622-6847
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Country | US
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Telephone | 706-995-3160
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Fax | 706-243-4611
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/CO-OWNER
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Name | KRISTEN MICHENER
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Credential | PH.D.
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Telephone | 706-995-3160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY003136
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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 | PSY002990
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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 | PSY002990
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY003136
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License Number State | GA
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