Provider Demographics
NPI:1891312732
Name:HEALTHY BALANCE PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:HEALTHY BALANCE PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLA-BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-277-9194
Mailing Address - Street 1:1550 SUNSET DR SW
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3854
Mailing Address - Country:US
Mailing Address - Phone:404-277-9194
Mailing Address - Fax:
Practice Address - Street 1:220 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5279
Practice Address - Country:US
Practice Address - Phone:507-475-4721
Practice Address - Fax:507-323-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA874147128AMedicaid