Provider Demographics
NPI:1467136598
Name:WELL BALANCED LLC
Entity Type:Organization
Organization Name:WELL BALANCED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:251-508-5380
Mailing Address - Street 1:171 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1444
Mailing Address - Country:US
Mailing Address - Phone:251-508-5380
Mailing Address - Fax:
Practice Address - Street 1:171 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1444
Practice Address - Country:US
Practice Address - Phone:251-508-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty