Provider Demographics
NPI:1699533653
Name:INNER BALANCE MENTAL HEALTH & WELLNESS, P.C.
Entity type:Organization
Organization Name:INNER BALANCE MENTAL HEALTH & WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-205-7302
Mailing Address - Street 1:1840 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21153-0663
Mailing Address - Country:US
Mailing Address - Phone:410-205-7302
Mailing Address - Fax:
Practice Address - Street 1:1840 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:MD
Practice Address - Zip Code:21153-0663
Practice Address - Country:US
Practice Address - Phone:410-205-7302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty