Provider Demographics
NPI:1083258370
Name:LIFE BALANCE COUNSELING, LLC
Entity Type:Organization
Organization Name:LIFE BALANCE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:239-312-5352
Mailing Address - Street 1:6237 PRESIDENTIAL CT STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3508
Mailing Address - Country:US
Mailing Address - Phone:239-312-5352
Mailing Address - Fax:239-230-3029
Practice Address - Street 1:6237 PRESIDENTIAL CT STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3508
Practice Address - Country:US
Practice Address - Phone:239-312-5352
Practice Address - Fax:239-230-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty