Healthcare Provider Details

I. General information

NPI: 1295425890
Provider Name (Legal Business Name): BALANCE PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16009 PETALUMA PL
EDMOND OK
73013-2201
US

IV. Provider business mailing address

3035 NW 63RD ST STE 227
OKLAHOMA CITY OK
73116-3631
US

V. Phone/Fax

Practice location:
  • Phone: 917-200-1461
  • Fax:
Mailing address:
  • Phone: 405-242-6460
  • Fax: 405-544-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: SHEENA MEHTA
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 917-200-1461