Provider Demographics
NPI:1427940790
Name:BEHAVIOR IN BALANCE BIB PC
Entity type:Organization
Organization Name:BEHAVIOR IN BALANCE BIB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:801-889-5692
Mailing Address - Street 1:185 W 12TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-5522
Mailing Address - Country:US
Mailing Address - Phone:801-889-5692
Mailing Address - Fax:
Practice Address - Street 1:2510 WASHINGTON BLVD STE 180
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3120
Practice Address - Country:US
Practice Address - Phone:385-438-6829
Practice Address - Fax:385-265-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-19
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty