NPIMap

Organization Active NPI

Balanced Mindset Counseling and Psychological SVCS, PLLC

  • Counseling Psychologist
  • Charlotte, NC
National Provider Identifier
1396223160
Registry record updated Aug 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
3660 Issued in NC
Legal business name
BALANCED MINDSET COUNSELING AND PSYCHOLOGICAL SVCS, PLLC
Practice address
10130 Mallard Creek Rd Ste 300
Charlotte, NC 28262-6001
Phone
(704) 944-3572
Fax
(704) 944-3101
NPI assigned
Aug 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2018

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

Authorized official

Name
Dr. Gene R. Edwards, PH.D.
Title
Owner
Phone
(704) 944-3572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC1900X 3660 NC Primary

Addresses

Primary practice location

10130 Mallard Creek Rd Ste 300
Charlotte, NC 28262-6001

Mailing address

10130 Mallard Creek Rd Ste 300
Charlotte, NC 28262-6001
Phone (704) 944-3572

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533168000000",
    "number": "1396223160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626001",
            "telephone_number": "704-944-3572",
            "fax_number": "704-944-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626001",
            "telephone_number": "704-944-3572",
            "fax_number": "704-944-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED MINDSET COUNSELING AND PSYCHOLOGICAL SVCS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-02",
        "last_updated": "2018-08-02",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "GENE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-944-3572",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "NC",
            "license": "3660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; 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.