Provider Demographics
NPI:1316646953
Name:MINDFUL BALANCE MENTAL HEALTH & WELLNESS, LLC
Entity type:Organization
Organization Name:MINDFUL BALANCE MENTAL HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAMIEN
Authorized Official - Last Name:PERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-434-0462
Mailing Address - Street 1:5325 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-2632
Mailing Address - Country:US
Mailing Address - Phone:586-214-2218
Mailing Address - Fax:
Practice Address - Street 1:1124 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1133
Practice Address - Country:US
Practice Address - Phone:810-434-0462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty