NPIMap

Organization Active NPI

Balance & Potential Inc

  • Clinical Psychologist
  • Roswell, GA
National Provider Identifier
1073906707
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY003755 Issued in GA
Legal business name
BALANCE & POTENTIAL INC
Practice address
555 Sun Valley Dr Ste P4
Roswell, GA 30076-5633
Phone
(678) 644-0039
Fax
(678) 669-2740
NPI assigned
Mar 4, 2015
Last updated
Mar 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kirsten Moore, PSY.D.NPI 1588813299
Title
President
Phone
(678) 644-0039

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY003755 GA
Cognitive & Behavioral Psychologist 103TB0200X PSY003755 GA
Clinical Psychologist 103TC0700X PSY003755 GA Primary
Clinical Child & Adolescent Psychologist 103TC2200X PSY003755 GA
Group Psychotherapy Psychologist 103TP2701X PSY003755 GA

Addresses

Primary practice location

555 Sun Valley Dr Ste P4
Roswell, GA 30076-5633

Mailing address

555 Sun Valley Dr Ste P4
Roswell, GA 30076-5633
Phone (678) 644-0039

Other identifiers 1

IdentifierTypeStateIssuer
003148513AMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1073906707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 SUN VALLEY DR STE P4",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765633",
            "telephone_number": "678-644-0039",
            "fax_number": "678-669-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 SUN VALLEY DR STE P4",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765633",
            "telephone_number": "678-644-0039",
            "fax_number": "678-669-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCE & POTENTIAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-644-0039",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY003755",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "GA",
            "license": "PSY003755",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003755",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "PSY003755",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "GA",
            "license": "PSY003755",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003148513A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.