Provider Demographics
NPI:1912644865
Name:BALANSERA THERAPY GROUP
Entity Type:Organization
Organization Name:BALANSERA THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SADIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:724-622-9155
Mailing Address - Street 1:6501 ARLINGTON EXPRESSWAY
Mailing Address - Street 2:B105 #2009
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211
Mailing Address - Country:US
Mailing Address - Phone:724-622-9155
Mailing Address - Fax:
Practice Address - Street 1:433 CODY DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4214
Practice Address - Country:US
Practice Address - Phone:724-622-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health