Healthcare Provider Details

I. General information

NPI: 1679481824
Provider Name (Legal Business Name): BALANCED MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10376 HANLEY STREET
CROWN POINT IN
46307-2820
US

IV. Provider business mailing address

885 SOUTH COLLEGE MALL ROAD PMB 288
BLOOMINGTON IN
47401-6847
US

V. Phone/Fax

Practice location:
  • Phone: 219-512-5459
  • Fax:
Mailing address:
  • Phone: 219-512-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KYLE FOUCH
Title or Position: PROVIDER
Credential: PMHNP
Phone: 219-512-5459