Provider Demographics
NPI:1205078532
Name:MADE FOR KIDS, INC.
Entity type:Organization
Organization Name:MADE FOR KIDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHENER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-995-3160
Mailing Address - Street 1:182 BEN BURTON CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-6847
Mailing Address - Country:US
Mailing Address - Phone:706-995-3160
Mailing Address - Fax:706-243-4611
Practice Address - Street 1:182 BEN BURTON CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-6847
Practice Address - Country:US
Practice Address - Phone:706-995-3160
Practice Address - Fax:706-243-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003136103TC0700X, 103TC2200X
GAPSY002990103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty