Mindful Balance Therapy, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MINDFUL BALANCE THERAPY, PLLC

Practice address

3175 Sienna Dr S Ste 101
Fargo, ND 58104-8910

Phone

(701) 922-0857

NPI assigned

Apr 11, 2023

Organization subpart

No

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

Authorized official

Name

Tracey Klobuchar, LCSWNPI 1952675860

Title

Owner/Therapist

Phone

(701) 922-0857

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Tracey Lynn Klobuchar, LSW

  • Clinical Social Worker
  • Fargo, ND
  • NPI 1952675860
  NPD Authorized official

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1346935681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3175 SIENNA DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048910",
            "telephone_number": "701-922-0857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3175 SIENNA DR S STE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048910",
            "telephone_number": "701-922-0857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL BALANCE THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-11",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "KLOBUCHAR",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "701-922-0857",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie A Miller, PA-C
• Taneka Amoya Miller, NP
• Timothy Isaac Miller
• Amna Abraham Millewa
• Carl Millien
• Mindful River Psychotherapy PLLC
• Mindwell Behavioral Health
• Patricia Minihan
• Anthony Minke, NP
• Carlos Daniel Miranda III, M.D.

• Clinical Social Worker in Fargo, ND
• Providers in Fargo, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.