Healthy Balance Psychology, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

HEALTHY BALANCE PSYCHOLOGY, LLC

Practice address

220 Central Ave N
Faribault, MN 55021-5279

Phone

(507) 475-4721

Fax

(507) 323-8204

NPI assigned

Jun 26, 2020

Last updated

Feb 6, 2021By 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

Heidi Halla-Bauer, PSY.D.NPI 1154521292

Title

Organizer, Owner

Phone

(404) 277-9194

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 5

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.

• Heidi Ann Halla-Bauer, PSY.D

  • Psychologist
  • Lagrange, GA
  • NPI 1154521292

  MN

  Medicare reassignment NPD Authorized official
• Hallie Costello

  • Clinical Social Worker
  • Faribault, MN
  • NPI 1881345379
  NPD (past)
• Kenda Marae Dougherty, CCC -SLP

  • Speech-Language Pathologist
  • Waseca, MN
  • NPI 1760681746
  NPD (past)
• Geri Shetka, LPCC

  • Professional Counselor
  • Faribault, MN
  • NPI 1720439649
  NPD (past)
• Ashley Ann Spain, OT

  • Occupational Therapist
  • Waseca, MN
  • NPI 1922621911
  NPD (past)

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612569600000",
    "number": "1891312732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 SUNSET DR SW",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550603854",
            "telephone_number": "404-277-9194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 CENTRAL AVE N",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215279",
            "telephone_number": "507-475-4721",
            "fax_number": "507-323-8204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1550 Sunset Dr SW",
            "address_purpose": "LOCATION",
            "city": "Owatonna",
            "state": "MN",
            "postal_code": "550603854",
            "country_code": "US",
            "telephone_number": "404-277-9194",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 2nd Ave SE",
            "address_purpose": "LOCATION",
            "city": "Waseca",
            "state": "MN",
            "postal_code": "560933041",
            "country_code": "US",
            "telephone_number": "507-475-4721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HEALTHY BALANCE PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-26",
        "last_updated": "2021-02-06",
        "certification_date": "2021-02-06",
        "status": "A",
        "authorized_official_last_name": "HALLA-BAUER",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_title_or_position": "ORGANIZER, OWNER",
        "authorized_official_telephone_number": "404-277-9194",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "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
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "874147128A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.healthybalancepsychology.com",
            "affiliation": "N",
            "address_1": "1550 Sunset Dr SW",
            "city": "Owatonna",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550603854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mohamed Hassan
• Sumaya Bashir Hassen
• Megan Elizabeth Hazel, PA-C
• Healthcare Campus Imaging One, LLC
• Healthfinders Collaborative, Inc.
• Nancy Henrikson Sommers, M.S. CCC-SLP
• Lori Jean Henry, PTA
• Mayra Eunice Hernandez
• Michael A Hildebrandt, MD
• Hoisington Family Chiropractic, PA

• Psychologist in Faribault, MN
• Providers in Faribault, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.