Healthcare Provider Details

I. General information

NPI: 1891238432
Provider Name (Legal Business Name): ART OF BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 LYMAN AVE
OAK PARK IL
60304-1629
US

IV. Provider business mailing address

933 W LOCUST ST
DAVENPORT IA
52804-3851
US

V. Phone/Fax

Practice location:
  • Phone: 773-766-7727
  • Fax:
Mailing address:
  • Phone: 773-766-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.010218
License Number StateIL

VIII. Authorized Official

Name: ASHLYN E LOPEZ
Title or Position: MANAGING MEMBER
Credential: MA, LCPC
Phone: 773-766-7727