Mindful Psychological Services

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3587 Issued in GA

Legal business name

MINDFUL PSYCHOLOGICAL SERVICES

Practice address

288 S Main St Ste 300
Alpharetta, GA 30009-1944

Phone

(678) 775-8399

Fax

(770) 234-5889

NPI assigned

Oct 11, 2012

Organization subpart

No

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

Authorized official

Name

Erica Barnes, PSY.D.

Title

Clinical Psychologist

Phone

(678) 775-8399

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349913600000",
    "number": "1205188554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "288 S MAIN ST STE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300091944",
            "telephone_number": "678-775-8399",
            "fax_number": "770-234-5889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "288 S MAIN ST STE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300091944",
            "telephone_number": "678-775-8399",
            "fax_number": "770-234-5889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-11",
        "last_updated": "2012-10-11",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "678-775-8399",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "3587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003126255B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; 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.