Provider Demographics
NPI:1225485568
Name:EMPOWERING BALANCE, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:EMPOWERING BALANCE, A PSYCHOLOGICAL CORPORATION
Other - Org Name:EMPOWERING BALANCE THERAPY & ASSESSMENT, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:831-704-7257
Mailing Address - Street 1:6010 HIGHWAY 9 STE 1
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9535
Mailing Address - Country:US
Mailing Address - Phone:972-876-9131
Mailing Address - Fax:
Practice Address - Street 1:6010 HIGHWAY 9 STE 1
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9535
Practice Address - Country:US
Practice Address - Phone:972-876-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36032261QM0850X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health