Healthcare Provider Details

I. General information

NPI: 1912724105
Provider Name (Legal Business Name): BALANCED MIND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NEW YORK AVE APT 2
JERSEY CITY NJ
07307-1401
US

IV. Provider business mailing address

382 NE 191ST ST
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 551-229-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SARA DALY
Title or Position: DIRECTOR
Credential:
Phone: 551-229-2778