Healthcare Provider Details

I. General information

NPI: 1669337226
Provider Name (Legal Business Name): BALANCED RESILIENCE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 LONDONTOWN BLVD STE 130A
ELDERSBURG MD
21784-6439
US

IV. Provider business mailing address

4827 BUFFALO RD
MOUNT AIRY MD
21771-8223
US

V. Phone/Fax

Practice location:
  • Phone: 410-552-0773
  • Fax:
Mailing address:
  • Phone: 443-386-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANN FRY
Title or Position: OWNER
Credential: CRNP PMH
Phone: 443-386-3396