Provider Demographics
NPI:1437403862
Name:BALKE COUNSELING, LLC
Entity Type:Organization
Organization Name:BALKE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSE, LPC, NCC
Authorized Official - Phone:920-303-0968
Mailing Address - Street 1:143 WYLDEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7677
Mailing Address - Country:US
Mailing Address - Phone:920-303-0968
Mailing Address - Fax:
Practice Address - Street 1:1730 ALGOMA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2889
Practice Address - Country:US
Practice Address - Phone:920-231-1430
Practice Address - Fax:920-231-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3502-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty