Provider Demographics
NPI:1942875323
Name:BALANCED SOLUTION THERAPIES
Entity Type:Organization
Organization Name:BALANCED SOLUTION THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-277-9085
Mailing Address - Street 1:621 W LAWRENCE ST # 105
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5834
Mailing Address - Country:US
Mailing Address - Phone:920-277-9085
Mailing Address - Fax:
Practice Address - Street 1:621 W LAWRENCE ST # 105
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5834
Practice Address - Country:US
Practice Address - Phone:920-277-9085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty