MEDICARE: BALANCE BEHAVIORAL HEALTH LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1104794676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1721 E OSAGE RD STE 300
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-2290
Country	:	US
Telephone Number	:	316-519-8662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 E OSAGE RD STE 300
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-2290
Country	:	US
Telephone Number	:	316-519-8662
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	STEPHANIE MCCLELLAN
Credential	:	PMHNP-C
Telephone Number	:	316-519-8662

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	10/27/2025

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