Provider Demographics
NPI:1871185173
Name:BALANCE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:BALANCE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRENNECKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-405-2784
Mailing Address - Street 1:200 W GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4366
Mailing Address - Country:US
Mailing Address - Phone:312-405-2784
Mailing Address - Fax:
Practice Address - Street 1:700 N GREEN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5996
Practice Address - Country:US
Practice Address - Phone:312-405-2784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty