Healthcare Provider Details

I. General information

NPI: 1093671646
Provider Name (Legal Business Name): CREATING BALANCE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 N LATROBE AVE
CHICAGO IL
60639-3013
US

IV. Provider business mailing address

2059 N LATROBE AVE
CHICAGO IL
60639-3013
US

V. Phone/Fax

Practice location:
  • Phone: 760-696-5110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHELLIAH WILLIAMS
Title or Position: FOUNDER
Credential:
Phone: 760-696-5110