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General NPI Number Information
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NPI Number | 1508487646
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Entity Type | Organization
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Legal Business Name | BALANCE PSYCHIATRY & WELLNESS PLLC
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Dates
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Enumeration Date | 04/29/2020
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 1218 E 9TH ST STE 4
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City | EDMOND
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State | OK
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Zip | 73034-5796
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Country | US
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Telephone | 405-563-3820
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Fax |
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Provider Business Mailing Address
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Address Line | 1218 E 9TH ST STE 4
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City | EDMOND
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State | OK
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Zip | 73034-5796
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Country | US
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Telephone | 405-563-3820
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST/OWNER
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Name | MICHELLE HOLLOWAY
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Credential | MD
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Telephone | 405-563-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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