MEDICARE: MINDFUL BALANCE EMOTIONAL HEALTH

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	:	1295602944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL BALANCE EMOTIONAL HEALTH

Provider Business Mailing Address
First Line	:	8084 WATSON RD STE 245
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5326
Country	:	US
Telephone Number	:	314-887-3304
Fax Number	:	314-207-2263

Provider Business Practice Location Address
First Line	:	8084 WATSON RD STE 245
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5326
Country	:	US
Telephone Number	:	314-887-3304
Fax Number	:	314-207-2263

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	RYAN M WALSH
Credential	:	PH.D.
Telephone Number	:	314-887-3304

Provider Enumeration Date	:	10/18/2025
Last Update Date	:	10/18/2025

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