Provider Demographics
NPI:1891359840
Name:BALANCE OF MIND COUNSELING AND BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:BALANCE OF MIND COUNSELING AND BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUISSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:262-210-9131
Mailing Address - Street 1:4330 CONIFER CT
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-9751
Mailing Address - Country:US
Mailing Address - Phone:262-864-9006
Mailing Address - Fax:
Practice Address - Street 1:4330 CONIFER CT
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9751
Practice Address - Country:US
Practice Address - Phone:262-864-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)