MEDICARE: BALANCE & BLOOM COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1023977907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE & BLOOM COUNSELING PLLC

Provider Business Mailing Address
First Line	:	2020 N CALIFORNIA AVE
Second Line	:	SUITE 7 #124
City	:	CHICAGO
State	:	IL
Zip	:	60647-6320
Country	:	US
Telephone Number	:	224-706-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1937 N MONTICELLO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3614
Country	:	US
Telephone Number	:	224-706-0808
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	RACHELLE RUBY
Credential	:	LPCP
Telephone Number	:	641-777-5279

Provider Enumeration Date	:	01/17/2026
Last Update Date	:	01/17/2026

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