| Equilibrium Brain Body Balance | |
|
12800 Whitewater Dr Suite 100- 2016 Minnetonka MN 55343 | |
| (612) 289-3465 | |
| Not Available |
| Full Name | Equilibrium Brain Body Balance |
|---|---|
| Speciality | Clinic/Center |
| Location | 12800 Whitewater Dr, Minnetonka, Minnesota |
| Authorized Official Name and Position | Therese M Houndt-dalberg (CEO/PMHNP) |
| Authorized Official Contact | 6122892365 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Equilibrium Brain Body Balance 7730 Laredo Dr Unit 163 Chanhassen MN 55317-1208 Ph: () - | Equilibrium Brain Body Balance 12800 Whitewater Dr Suite 100- 2016 Minnetonka MN 55343 Ph: (612) 289-3465 |
| NPI Number | 1861198723 |
|---|---|
| Provider Enumeration Date | 02/02/2023 |
| Last Update Date | 02/02/2023 |
| Certification Date | 02/02/2023 |
| Medicare PECOS PAC ID | 5395199665 |
|---|---|
| Medicare Enrollment ID | O20230921000417 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861198723 | NPI | - | NPPES |
| 1861858466 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Alene W Chelman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154635092 PECOS PAC ID: 5496906463 Enrollment ID: I20121126000024 |
| Provider Name | Taylor Ohotto Darnauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073095063 PECOS PAC ID: 4385042928 Enrollment ID: I20211012001180 |
| Provider Name | Therese Houndt-dalberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861858466 PECOS PAC ID: 0547659021 Enrollment ID: I20211123001448 |
| Provider Name | Grace Elizabeth Allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093359812 PECOS PAC ID: 4688012347 Enrollment ID: I20240401002944 |
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