Provider Demographics
NPI:1063098051
Name:MINDFUL BALANCE THERAPY
Entity type:Organization
Organization Name:MINDFUL BALANCE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KALANI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-264-0566
Mailing Address - Street 1:497 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5171
Mailing Address - Country:US
Mailing Address - Phone:847-264-0566
Mailing Address - Fax:
Practice Address - Street 1:497 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5171
Practice Address - Country:US
Practice Address - Phone:847-264-0566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180007388OtherIDFPR