# MINDFUL BALANCE THERAPY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346935681
- **Authorized official:** TRACEY KLOBUCHAR LCSW (OWNER/THERAPIST)
- **Authorized official phone:** (701) 922-0857

## Contact information

- **Practice address:** 3175 SIENNA DR S STE 101, FARGO, ND 58104-8910
- **Practice address phone:** (701) 922-0857
- **Mailing address:** 3175 SIENNA DR S, FARGO, ND 58104-8910
- **Mailing address phone:** (701) 922-0857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 04/11/2023
- **Last updated:** 08/21/2023