Provider Demographics
NPI:1518538297
Name:BALANCED MINDS MENTAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:BALANCED MINDS MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-986-0454
Mailing Address - Street 1:620 E BROAD ST STE T
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4037
Mailing Address - Country:US
Mailing Address - Phone:773-986-0454
Mailing Address - Fax:
Practice Address - Street 1:620 E BROAD ST STE T
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4037
Practice Address - Country:US
Practice Address - Phone:773-986-0454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty