Provider Demographics
NPI:1487923108
Name:BALANCE MENTAL HEALTH CARE
Entity type:Organization
Organization Name:BALANCE MENTAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRAIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-473-8988
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-7379
Mailing Address - Country:US
Mailing Address - Phone:304-473-8988
Mailing Address - Fax:304-472-9849
Practice Address - Street 1:11 N KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2713
Practice Address - Country:US
Practice Address - Phone:304-473-8988
Practice Address - Fax:304-472-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty