Provider Demographics
NPI:1790411700
Name:BALANCE FOR GROWTH
Entity Type:Organization
Organization Name:BALANCE FOR GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOMANS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, MSAT
Authorized Official - Phone:715-204-9433
Mailing Address - Street 1:227400 RIB MOUNTAIN DR STE G
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5049
Mailing Address - Country:US
Mailing Address - Phone:715-204-9433
Mailing Address - Fax:
Practice Address - Street 1:227400 RIB MOUNTAIN DR STE G
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5049
Practice Address - Country:US
Practice Address - Phone:715-204-9433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1730314105Medicaid