| Name: | Children In Balance Psychological Associates, LLC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 06 Sep 2012 (12 years ago) |
| Identification Number: | 000792969 |
| ZIP code: | 02842 |
| County: | Newport County |
| Principal Address: | 575 EAST MAIN ROAD UNIT 4, MIDDLETOWN, RI, 02842, USA |
| Mailing Address: | PO BOX 577, SOMERSET, MA, 02726, USA |
| Purpose: | CIB IS A BEHAVIORAL HEALTH AND MENTAL HEALTH WELLNESS PRACTICE. WE OFFER INDIVIDUAL, FAMILY, GROUP, AND COUPLES THERAPY FOR YOUTH,FAMILIES,ADULTS AND CHILDREN. OFFERING TELE-THERAPY, PLAY THERAPY, ADULT THERAPY SERVICES, CBT AS WELL AS THERAPEUTIC GROUPS TO ADDRESS A VARIETY OF NEEDS FOR ALL AGE GROUPS. |
| NAICS: | 621420 - Outpatient Mental Health and Substance Abuse Centers |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1952651895 | 2012-09-19 | 2017-04-26 | P.O. BOX 577, SOMERSET, MA, 02726, US | 575 E MAIN RD, 4, MIDDLETOWN, RI, 028425528, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 508-962-7364 |
| Fax | 4016197766 |
Authorized person
| Name | MISS TIFFANY BOURQUIN |
| Role | CEO/EXECUTIVE DIRECTOR |
| Phone | 5089627364 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | 00547 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | 6722 |
| State | MA |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | 7566 |
| State | MA |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | 7566 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | CSW01724 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | 02472 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | MHC00502 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 7566 |
| State | MA |
| Is Primary | No |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI 1669631487 |
| Number | 1669631487 |
| Issuer | MEDICAID |
| Number | BH90286 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| TIFFANY BOURQUIN | Agent | 575 EAST MAIN ROAD, MIDDLETOWN, RI, 02842, USA |
| Number | Name | File Date |
|---|---|---|
| 202451081890 | Annual Report | 2024-04-15 |
| 202332347730 | Annual Report | 2023-04-05 |
| 202215398240 | Annual Report | 2022-04-21 |
| 202102423660 | Annual Report | 2021-09-30 |
| 202077308070 | Annual Report | 2020-11-25 |
| 201917200150 | Annual Report | 2019-09-03 |
| 201985107900 | Annual Report | 2019-01-24 |
| 201878733470 | Statement of Change of Registered/Resident Agent Office | 2018-10-02 |
| 201877678880 | Revocation Notice For Failure to Maintain a Registered Office | 2018-09-18 |
| 201877137170 | Registered Office Not Maintained | 2018-08-20 |
Date of last update: 17 Oct 2024
Sources: Rhode Island Department of State
