Provider Demographics
NPI:1275106262
Name:BALANCED MIND THERAPY PLLC
Entity Type:Organization
Organization Name:BALANCED MIND THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALPINE-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-534-7122
Mailing Address - Street 1:27779 OSMUN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3337
Mailing Address - Country:US
Mailing Address - Phone:248-534-7122
Mailing Address - Fax:
Practice Address - Street 1:27779 OSMUN ST
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3337
Practice Address - Country:US
Practice Address - Phone:248-534-7122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health