MEDICARE: BALANCED MENTAL HEALTH AND WELLNESS 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	363LP2300X	Primary Care Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1932790037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED MENTAL HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	7929 N 76TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-3947
Country	:	US
Telephone Number	:	414-376-8830
Fax Number	:	414-376-6808

Provider Business Practice Location Address
First Line	:	7929 N 76TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-3947
Country	:	US
Telephone Number	:	414-376-8830
Fax Number	:	414-376-6808

Authorized Official
Title or Position	:	OWNER OF ENTITY
Name	:	OCTAVIA N MANUEL-WRIGHT
Credential	:
Telephone Number	:	414-376-8830

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	10/30/2025

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