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General NPI Number Information
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NPI Number | 1073018495
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Entity Type | Organization
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Legal Business Name | BALANCED MIND
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 127 S MCKEAN ST
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City | BUTLER
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State | PA
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Zip | 16001-6029
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Country | US
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Telephone | 724-991-1289
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Fax |
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Provider Business Mailing Address
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Address Line | 127 S MCKEAN ST
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City | BUTLER
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State | PA
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Zip | 16001-6029
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Country | US
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Telephone | 724-991-1289
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH J WAGNER
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Credential | LPC
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Telephone | 724-991-1289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC007100
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License Number State | PA
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