Provider Demographics
NPI:1043734551
Name:MENTAL HEALTH BALANCE & DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH BALANCE & DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:PHILPOTT
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LPC
Authorized Official - Phone:304-295-3345
Mailing Address - Street 1:1605 GRAND CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1081
Mailing Address - Country:US
Mailing Address - Phone:304-295-3345
Mailing Address - Fax:
Practice Address - Street 1:1605 GRAND CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-1081
Practice Address - Country:US
Practice Address - Phone:304-295-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty