Provider Demographics
NPI:1477782472
Name:LIFE BALANCE
Entity Type:Organization
Organization Name:LIFE BALANCE
Other - Org Name:ROBERT TUTT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TUTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-978-4749
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60146-0589
Mailing Address - Country:US
Mailing Address - Phone:815-978-4749
Mailing Address - Fax:
Practice Address - Street 1:5301 E STATE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2901
Practice Address - Country:US
Practice Address - Phone:815-978-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT TUTT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21746101YA0400X
IL180.006576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty