Provider Demographics
NPI:1346935681
Name:MINDFUL BALANCE THERAPY, PLLC
Entity Type:Organization
Organization Name:MINDFUL BALANCE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOBUCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-922-0857
Mailing Address - Street 1:3175 SIENNA DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8910
Mailing Address - Country:US
Mailing Address - Phone:701-922-0857
Mailing Address - Fax:
Practice Address - Street 1:3175 SIENNA DR S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8910
Practice Address - Country:US
Practice Address - Phone:701-922-0857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty