Organization
BALANCED COUNSELING AND CONSULTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RITA IRENE POLIVICK M.S. LCSW, LMHC (OWNER)
(260) 437-1248
Entity
Organization
Contact information
Practice address
2211 MAPLEWOOD RD, FORT WAYNE, IN 46819-1646
(260) 437-1248
(260) 478-4727
Mailing address
2211 MAPLEWOOD RD, FORT WAYNE, IN 46819-1646
(260) 437-1248
(260) 478-4727
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
34003316A
IN
101YM0800X
Mental Health Counselor
MH4219
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437387537
INDIVIDUAL NPI NUMBER
IN
Enumeration date
01/24/2011
Last updated
01/24/2011
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