Provider Demographics
NPI:1235775602
Name:BALANCED CONNECTIONS LLC
Entity Type:Organization
Organization Name:BALANCED CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:224-292-8833
Mailing Address - Street 1:464 CROSS ARM DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2762
Mailing Address - Country:US
Mailing Address - Phone:224-292-8833
Mailing Address - Fax:
Practice Address - Street 1:450 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1835
Practice Address - Country:US
Practice Address - Phone:224-292-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty