Healthcare Provider Details

I. General information

NPI: 1316535347
Provider Name (Legal Business Name): PRACTICAL BALANCE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 W CHARLESTON BLVD STE 140
LAS VEGAS NV
89117-1570
US

IV. Provider business mailing address

7331 W CHARLESTON BLVD STE 140
LAS VEGAS NV
89117-1570
US

V. Phone/Fax

Practice location:
  • Phone: 360-957-5898
  • Fax: 702-489-7844
Mailing address:
  • Phone: 360-957-5898
  • Fax: 702-489-7844

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
# 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: MARY VANDER VEER
Title or Position: LCPC/OWNER
Credential: MA
Phone: 360-957-5898