Provider Demographics
NPI:1053141143
Name:INNER BALANCE THERAPY
Entity type:Organization
Organization Name:INNER BALANCE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:872-265-2470
Mailing Address - Street 1:540 N. DEARBORN
Mailing Address - Street 2:PO BOX 10194
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:872-265-2470
Mailing Address - Fax:
Practice Address - Street 1:540 N. DEARBORN
Practice Address - Street 2:#10194
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:872-265-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty