Healthcare Provider Details

I. General information

NPI: 1083167076
Provider Name (Legal Business Name): BALANCED PERSPECTIVES PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S CLEVELAND AVE STE G1
WESTERVILLE OH
43081-8958
US

IV. Provider business mailing address

691 WESTRAY DR
WESTERVILLE OH
43081-7701
US

V. Phone/Fax

Practice location:
  • Phone: 614-808-3632
  • Fax: 614-452-6188
Mailing address:
  • Phone: 484-547-1078
  • Fax: 614-452-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6648
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANN MARIE HETZEL
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 484-547-1078