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General NPI Number Information
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NPI Number | 1518527258
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Entity Type | Organization
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Legal Business Name | BALANCED PSYCHOLOGY SERVICES
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Dates
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Enumeration Date | 06/15/2019
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Last Update Date | 06/15/2019
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Provider Practice Location Address
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Address Line | 2777 JEFFERSON ST STE 203
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City | CARLSBAD
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State | CA
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Zip | 92008-1743
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Country | US
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Telephone | 760-385-8426
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Fax |
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Provider Business Mailing Address
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Address Line | 560 MOONLIGHT DR
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City | SAN MARCOS
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State | CA
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Zip | 92069-2067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST / PRESIDENT
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Name | DR. KELSEY MICHAEL BRADSHAW
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Credential | PHD
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Telephone | 208-310-9884
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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 |
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License Number State |
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