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Organization
CREATE YOUR BALANCE MENTAL HEALTH COUNSELING
Active
Organization
CREATE YOUR BALANCE MENTAL HEALTH COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JILLIAN LAUREN DECOURSEY LMHC (OWNER)
(917) 239-5734
Entity
Organization
Contact information
Practice address
25410 NORTHERN BLVD STE 211, LITTLE NECK, NY 11362-1415
(917) 239-5734
(718) 819-1148
Mailing address
25410 NORTHERN BLVD STE 211, LITTLE NECK, NY 11362-1415
(917) 239-5734
(718) 819-1148
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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