# BALANCED COUNSELING AND CONSULTATION

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

## Provider details

- **NPI number:** 1891090783
- **Authorized official:** RITA IRENE POLIVICK M.S. LCSW, LMHC (OWNER)
- **Authorized official phone:** (260) 437-1248

## Contact information

- **Practice address:** 2211 MAPLEWOOD RD, FORT WAYNE, IN 46819-1646
- **Practice address phone:** (260) 437-1248
- **Practice address fax:** (260) 478-4727
- **Mailing address:** 2211 MAPLEWOOD RD, FORT WAYNE, IN 46819-1646
- **Mailing address phone:** (260) 437-1248
- **Mailing address fax:** (260) 478-4727

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 34003316A | IN | Yes |
| 101YM0800X | Mental Health Counselor | MH4219 | FL | — |

## Other

- **Enumeration date:** 01/24/2011
- **Last updated:** 01/24/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1437387537 | INDIVIDUAL NPI NUMBER | IN |