=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629855549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALANCE PSYCHIATRIC MENTAL HEALTH & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2023
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 S 3RD ST
-----------------------------------------------------
City | SHELTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98584-3533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-358-3039
-----------------------------------------------------
Fax | 651-666-1427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2142 W RAILROAD AVE
-----------------------------------------------------
City | SHELTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98584-7813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-358-1445
-----------------------------------------------------
Fax | 651-666-1427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ASHLEY N MABRY
-----------------------------------------------------
Credential | ARNP, PMHNP-BC
-----------------------------------------------------
Telephone | 360-358-3039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------