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General NPI Number Information
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NPI Number | 1124762703
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Entity Type | Organization
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Legal Business Name | THE BALM WITHIN, LLC
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 29551 GREENFIELD RD STE 112
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5871
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Country | US
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Telephone | 989-520-1744
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Fax |
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Provider Business Mailing Address
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Address Line | 29551 GREENFIELD RD STE 112
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5871
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Country | US
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Telephone | 989-520-1744
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY E PHILLIPS
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Credential | LMSW
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Telephone | 814-360-0662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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