MEDICARE: BALANCE STRESS MANAGEMENT & THERAPY

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	106H00000X	Marriage & Family Therapist	166.000876	IL

General Provider Information

NPI Number	:	1609235274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE STRESS MANAGEMENT & THERAPY

Provider Business Mailing Address
First Line	:	915 E PARKVIEW DR
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-3262
Country	:	US
Telephone Number	:	815-761-3622
Fax Number	:	855-260-8266

Provider Business Practice Location Address
First Line	:	915 E PARKVIEW DR
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-3262
Country	:	US
Telephone Number	:	815-761-3622
Fax Number	:	855-260-8266

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. AMY MELISSA SCHILLINGER
Credential	:	LMFT
Telephone Number	:	815-761-3622

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	02/11/2016

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