Provider Demographics
NPI:1225757552
Name:REBALANCE MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:REBALANCE MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BULK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-335-1718
Mailing Address - Street 1:340 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-8942
Mailing Address - Country:US
Mailing Address - Phone:231-588-3362
Mailing Address - Fax:231-368-6283
Practice Address - Street 1:340 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8942
Practice Address - Country:US
Practice Address - Phone:231-588-3362
Practice Address - Fax:231-368-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty