Provider Demographics
NPI:1487182739
Name:BALANCE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:BALANCE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBEC
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-904-7984
Mailing Address - Street 1:16242 SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1434
Mailing Address - Country:US
Mailing Address - Phone:734-904-7984
Mailing Address - Fax:
Practice Address - Street 1:41 WASHINGTON AVE STE 280B
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1390
Practice Address - Country:US
Practice Address - Phone:734-904-7984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010939351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty