Provider Demographics
NPI:1467601674
Name:HEALTH BALANCE INTERNATIONAL
Entity Type:Organization
Organization Name:HEALTH BALANCE INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUSKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-688-2628
Mailing Address - Street 1:1627 FOOTHILL DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2739
Mailing Address - Country:US
Mailing Address - Phone:801-688-2628
Mailing Address - Fax:801-906-0735
Practice Address - Street 1:1627 FOOTHILL DR
Practice Address - Street 2:SUITE 10
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2739
Practice Address - Country:US
Practice Address - Phone:801-688-2628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty