Create Your Balance Mental Health Counseling

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CREATE YOUR BALANCE MENTAL HEALTH COUNSELING

Practice address

25410 Northern Blvd Ste 211
Little Neck, NY 11362-1415

Phone

(917) 239-5734

Fax

(718) 819-1148

NPI assigned

Jan 5, 2022

Last updated

Jan 5, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jillian Lauren Decoursey, LMHCNPI 1093132391

Title

Owner

Phone

(917) 239-5734

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jillian Lauren Decoursey, LMHC

  • Mental Health Counselor
  • Middle Village, NY
  • NPI 1093132391
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1073274627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25410 NORTHERN BLVD STE 211",
            "city": "LITTLE NECK",
            "state": "NY",
            "postal_code": "113621415",
            "telephone_number": "917-239-5734",
            "fax_number": "718-819-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25410 NORTHERN BLVD STE 211",
            "city": "LITTLE NECK",
            "state": "NY",
            "postal_code": "113621415",
            "telephone_number": "917-239-5734",
            "fax_number": "718-819-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATE YOUR BALANCE MENTAL HEALTH COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "DECOURSEY",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_middle_name": "LAUREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-239-5734",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Little Neck, NY
• Providers in Little Neck, NY by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.