Chattahoochee Child Psychology

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

3114 Issued in GA

Legal business name

CHATTAHOOCHEE CHILD PSYCHOLOGY

Practice address

430 Prior Street NE
Gainesville, GA 30501

Phone

(678) 971-5355

Fax

(678) 971-5359

NPI assigned

Feb 2, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Kristen W Green, PHD

Title

Owner/Psychologist

Phone

(678) 971-5355

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1265068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1487986493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 PRIOR STREET NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "678-971-5355",
            "fax_number": "678-971-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 PRIOR STREET NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "678-971-5355",
            "fax_number": "678-971-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHATTAHOOCHEE CHILD PSYCHOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-02",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "678-971-5355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "3114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Clinical Child & Adolescent Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.