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General NPI Number Information
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NPI Number | 1063256089
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Entity Type | Organization
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Legal Business Name | BALANCE PSYCHIATRY AND WELLNESS LLC
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Dates
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Enumeration Date | 06/24/2024
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 142 E GORE ST
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City | ORLANDO
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State | FL
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Zip | 32806-1223
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Country | US
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Telephone | 307-388-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 142 E GORE ST
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City | ORLANDO
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State | FL
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Zip | 32806-1223
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Country | US
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Telephone | 307-388-0400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIANE OLSON
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Credential | APRN, PMHNP-BC
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Telephone | 307-388-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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