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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