Provider Demographics
NPI:1932790037
Name:BALANCED MENTAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:BALANCED MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANUEL-WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-376-8830
Mailing Address - Street 1:7929 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3947
Mailing Address - Country:US
Mailing Address - Phone:414-376-8830
Mailing Address - Fax:414-376-6808
Practice Address - Street 1:7929 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-3947
Practice Address - Country:US
Practice Address - Phone:414-376-8830
Practice Address - Fax:414-376-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty