Provider Demographics
NPI:1144104522
Name:MINDFUL BALANCE PLLC
Entity type:Organization
Organization Name:MINDFUL BALANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:OMORAGBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-366-5705
Mailing Address - Street 1:1230 RIVER BEND DR STE 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4916
Mailing Address - Country:US
Mailing Address - Phone:972-366-5705
Mailing Address - Fax:
Practice Address - Street 1:1230 RIVER BEND DR STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4916
Practice Address - Country:US
Practice Address - Phone:723-665-7059
Practice Address - Fax:972-337-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty