Provider Demographics
NPI:1467065672
Name:LIFE BALANCE COUNSELING PEORIA, PLLC
Entity Type:Organization
Organization Name:LIFE BALANCE COUNSELING PEORIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DEWANE
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:309-264-9410
Mailing Address - Street 1:7722 N ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1114
Mailing Address - Country:US
Mailing Address - Phone:309-264-9410
Mailing Address - Fax:309-214-0096
Practice Address - Street 1:7722 N ALLEN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1114
Practice Address - Country:US
Practice Address - Phone:309-264-9410
Practice Address - Fax:309-214-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty