NPIMap

Organization Active NPI

Balanced Mind Psychotherapy, LLC

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1194437962
Registry record updated Dec 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
BALANCED MIND PSYCHOTHERAPY, LLC
Practice address
180 N Michigan Ave Ste 1510
Chicago, IL 60601-7484
Phone
(708) 831-3782
NPI assigned
Dec 23, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2022

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

Authorized official

Name
Jamie Dunlap, LCPCNPI 1396200861
Title
Owner/Practice Manger and Therapist
Phone
(309) 236-0501

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

180 N Michigan Ave Ste 1510
Chicago, IL 60601-7484

Mailing address

2321 11TH St
Moline, IL 61265-4756
Phone (708) 831-3782

Other identifiers 1

IdentifierTypeStateIssuer
14410974OtherILCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL balancedmindtherapy312@gmail.com Other

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1671753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671753600000",
    "number": "1194437962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 11TH ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654756",
            "telephone_number": "708-831-3782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 N MICHIGAN AVE STE 1510",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017484",
            "telephone_number": "708-831-3782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED MIND PSYCHOTHERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-23",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A",
        "authorized_official_last_name": "DUNLAP",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "OWNER/PRACTICE MANGER AND THERAPIST",
        "authorized_official_telephone_number": "309-236-0501",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNCIL FOR AFFORDABLE QUALITY HEALTHCARE",
            "identifier": "14410974",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "balancedmindtherapy312@gmail.com",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "email",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "180 N Michigan Ave Ste 1510",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606017484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.