Provider Demographics
NPI:1396578241
Name:MODERN BALANCE INTEGRATIVE THERAPY, LLC
Entity type:Organization
Organization Name:MODERN BALANCE INTEGRATIVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:COLAIANNI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MSW, LCSW
Authorized Official - Phone:623-826-2771
Mailing Address - Street 1:589 BEACONSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-4311
Mailing Address - Country:US
Mailing Address - Phone:623-826-2771
Mailing Address - Fax:
Practice Address - Street 1:589 BEACONSFIELD AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-4311
Practice Address - Country:US
Practice Address - Phone:623-826-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODERN BALANCE INTEGRATIVE THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty