Provider Demographics
NPI:1629567458
Name:A BALANCED MIND, LLC
Entity type:Organization
Organization Name:A BALANCED MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KELLER GATES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-833-3935
Mailing Address - Street 1:PO BOX 13353
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-1353
Mailing Address - Country:US
Mailing Address - Phone:405-312-5661
Mailing Address - Fax:
Practice Address - Street 1:8541 HURST CT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-4402
Practice Address - Country:US
Practice Address - Phone:405-312-5661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200619800CMedicaid