Provider Demographics
NPI:1316535347
Name:PRACTICAL BALANCE COUNSELING, PLLC
Entity Type:Organization
Organization Name:PRACTICAL BALANCE COUNSELING, PLLC
Other - Org Name:MARY VANDER VEER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER VEER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-957-5898
Mailing Address - Street 1:7331 W CHARLESTON BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1570
Mailing Address - Country:US
Mailing Address - Phone:360-957-5898
Mailing Address - Fax:702-489-7844
Practice Address - Street 1:7331 W CHARLESTON BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1570
Practice Address - Country:US
Practice Address - Phone:360-957-5898
Practice Address - Fax:702-489-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2054842Medicaid
NV1801149745Medicaid