Provider Demographics
NPI:1154510279
Name:INNER BALANCE PSYCHOTHERAPY SERVICES LTD
Entity Type:Organization
Organization Name:INNER BALANCE PSYCHOTHERAPY SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-244-9620
Mailing Address - Street 1:561 W DIVERSEY PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6068
Mailing Address - Country:US
Mailing Address - Phone:773-244-9620
Mailing Address - Fax:773-244-9622
Practice Address - Street 1:561 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6068
Practice Address - Country:US
Practice Address - Phone:773-244-9620
Practice Address - Fax:773-244-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health