Healthcare Provider Details

I. General information

NPI: 1932790037
Provider Name (Legal Business Name): BALANCED MENTAL HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7929 N 76TH ST
MILWAUKEE WI
53223-3947
US

IV. Provider business mailing address

7929 N 76TH ST
MILWAUKEE WI
53223-3947
US

V. Phone/Fax

Practice location:
  • Phone: 414-376-8830
  • Fax: 414-376-6808
Mailing address:
  • Phone: 414-376-8830
  • Fax: 414-376-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OCTAVIA N MANUEL-WRIGHT
Title or Position: OWNER OF ENTITY
Credential:
Phone: 414-376-8830