Healthcare Provider Details

I. General information

NPI: 1891312732
Provider Name (Legal Business Name): HEALTHY BALANCE PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 02/06/2021
Certification Date: 02/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CENTRAL AVE N
FARIBAULT MN
55021-5279
US

IV. Provider business mailing address

1550 SUNSET DR SW
OWATONNA MN
55060-3854
US

V. Phone/Fax

Practice location:
  • Phone: 507-475-4721
  • Fax: 507-323-8204
Mailing address:
  • Phone: 404-277-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEIDI HALLA-BAUER
Title or Position: ORGANIZER, OWNER
Credential: PSY.D.
Phone: 404-277-9194