Provider Demographics
NPI:1366000754
Name:A BALANCED LIFE LLC
Entity Type:Organization
Organization Name:A BALANCED LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RASHELL
Authorized Official - Last Name:VIRGIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-221-4259
Mailing Address - Street 1:1322 NW JOHN JONES DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8040
Mailing Address - Country:US
Mailing Address - Phone:682-224-6218
Mailing Address - Fax:817-887-4157
Practice Address - Street 1:1322 NW JOHN JONES DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8040
Practice Address - Country:US
Practice Address - Phone:682-224-6218
Practice Address - Fax:817-887-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health