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General NPI Number Information
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NPI Number | 1225757552
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Entity Type | Organization
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Legal Business Name | REBALANCE MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 340 ADAMS ST
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City | NEWAYGO
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State | MI
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Zip | 49337-8942
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Country | US
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Telephone | 231-588-3362
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Fax | 231-368-6283
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Provider Business Mailing Address
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Address Line | 340 ADAMS ST
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City | NEWAYGO
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State | MI
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Zip | 49337-8942
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Country | US
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Telephone | 231-588-3362
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Fax | 231-368-6283
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Authorized Official
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Title or Position | OWNER
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Name | KELLY BULK
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Credential |
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Telephone | 231-335-1718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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