Provider Demographics
NPI:1013778463
Name:BALANCED MINDS THERAPY LLC
Entity Type:Organization
Organization Name:BALANCED MINDS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LISW-S
Authorized Official - Phone:937-825-0552
Mailing Address - Street 1:924 EASTWIND DR STE 7
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3329
Mailing Address - Country:US
Mailing Address - Phone:937-787-6178
Mailing Address - Fax:
Practice Address - Street 1:924 EASTWIND DR STE 7
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3329
Practice Address - Country:US
Practice Address - Phone:937-787-6178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)