Healthcare Provider Details

I. General information

NPI: 1043004062
Provider Name (Legal Business Name): CONQUERED BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43996 WOODWARD AVE STE 5-2151
BLOOMFIELD HILLS MI
48302-5027
US

IV. Provider business mailing address

43996 WOODWARD AVE STE 5-2151
BLOOMFIELD HILLS MI
48302-5027
US

V. Phone/Fax

Practice location:
  • Phone: 989-573-6374
  • Fax: 989-500-0778
Mailing address:
  • Phone: 989-573-6374
  • Fax: 989-500-0778

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: ODESSHA YORK
Title or Position: FOUNDER
Credential: NP
Phone: 989-780-4904