Provider Demographics
NPI:1598565558
Name:WISCONSIN FAMILY MENTAL BALANCE
Entity type:Organization
Organization Name:WISCONSIN FAMILY MENTAL BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-820-1395
Mailing Address - Street 1:4710 E BROADWAY STE 140
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4109
Mailing Address - Country:US
Mailing Address - Phone:608-820-1395
Mailing Address - Fax:608-820-1395
Practice Address - Street 1:4710 E BROADWAY STE 140
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-4109
Practice Address - Country:US
Practice Address - Phone:608-820-1395
Practice Address - Fax:608-820-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty