Provider Demographics
NPI:1124423975
Name:MINDFUL BALANCE THERAPY CENTER P.L.L.C
Entity type:Organization
Organization Name:MINDFUL BALANCE THERAPY CENTER P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:VIOLET
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:603-903-1414
Mailing Address - Street 1:63 EMERALD ST # 102
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3626
Mailing Address - Country:US
Mailing Address - Phone:603-903-1414
Mailing Address - Fax:833-693-0222
Practice Address - Street 1:63 EMERALD ST # 102
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3626
Practice Address - Country:US
Practice Address - Phone:603-903-1414
Practice Address - Fax:833-693-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100005Medicaid