Provider Demographics
NPI:1588073860
Name:CREATING BALANCE LLC
Entity type:Organization
Organization Name:CREATING BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/SOLEPROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POHLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:262-894-3540
Mailing Address - Street 1:385 WILLIAMSTOWNE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2323
Mailing Address - Country:US
Mailing Address - Phone:262-894-3540
Mailing Address - Fax:262-303-4765
Practice Address - Street 1:385 WILLIAMSTOWNE
Practice Address - Street 2:SUITE 105
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2323
Practice Address - Country:US
Practice Address - Phone:262-894-3540
Practice Address - Fax:262-303-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3946-125261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43725200Medicaid