Provider Demographics
NPI:1629855549
Name:BALANCE PSYCHIATRIC MENTAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:BALANCE PSYCHIATRIC MENTAL HEALTH & WELLNESS
Other - Org Name:BALANCE PSYCHIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, PMHNP-BC
Authorized Official - Phone:360-358-1445
Mailing Address - Street 1:221 W RAILROAD AVE STE K
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2142 W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-7813
Practice Address - Country:US
Practice Address - Phone:360-358-1445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty