| Balance Of Mind Therapeutic Support | |
|
308 4th Ave Nw Austin MN 55912-3140 | |
| (507) 438-4026 | |
| Not Available |
| Full Name | Balance Of Mind Therapeutic Support |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 308 4th Ave Nw, Austin, Minnesota |
| Authorized Official Name and Position | Daryl James Smith (OWNER) |
| Authorized Official Contact | 5074384026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Balance Of Mind Therapeutic Support 308 4th Ave Nw Austin MN 55912-3140 Ph: (507) 438-4026 | Balance Of Mind Therapeutic Support 308 4th Ave Nw Austin MN 55912-3140 Ph: (507) 438-4026 |
| NPI Number | 1841862364 |
|---|---|
| Provider Enumeration Date | 07/14/2021 |
| Last Update Date | 02/06/2023 |
| Certification Date | 02/06/2023 |
| Medicare PECOS PAC ID | 6608264460 |
|---|---|
| Medicare Enrollment ID | O20211027001757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841862364 | NPI | - | NPPES |
| 1871018192 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Daryl Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871018192 PECOS PAC ID: 5092088872 Enrollment ID: I20170829004206 |
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