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General NPI Number Information
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NPI Number | 1194437962
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Entity Type | Organization
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Legal Business Name | BALANCED MIND PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 12/23/2022
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 180 N MICHIGAN AVE STE 1510
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City | CHICAGO
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State | IL
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Zip | 60601-7484
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Country | US
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Telephone | 708-831-3782
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Fax |
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Provider Business Mailing Address
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Address Line | 2321 11TH ST
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City | MOLINE
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State | IL
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Zip | 61265-4756
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Country | US
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Telephone | 708-831-3782
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTICE MANGER AND THERAPIST
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Name | JAMIE DUNLAP
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Credential | LCPC
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Telephone | 309-236-0501
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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 |
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License Number State |
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