Provider Demographics
NPI:1063855609
Name:BALANCED LIVING THERAPY, LLC
Entity Type:Organization
Organization Name:BALANCED LIVING THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED MENTAL HEALTH COUNS
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ISHAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, SUDP, CCF
Authorized Official - Phone:425-977-4988
Mailing Address - Street 1:7500 212TH ST SW STE 205
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7617
Mailing Address - Country:US
Mailing Address - Phone:425-977-4988
Mailing Address - Fax:425-977-4989
Practice Address - Street 1:7500 212TH ST SW STE 205
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7617
Practice Address - Country:US
Practice Address - Phone:425-977-4988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-13
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA916313OtherCARPENTERS HEALTH AND SECURITY PLAN
WA2150671Medicaid
WA909035OtherAETNA
WA912650OtherLIFEWISE OF WA
WA1950283OtherPROVIDENCE HEALTH PLAN OF WASHINGTON
WA1253932OtherKAISER
WA1560659OtherMOLINA HEALTH CARE OF WASHINGTON
WA909040OtherFIRST CHOICE HEALTH NETWORK
WA1554873OtherCOMMUNITY HEALTH PLAN OF WASHINGTON