Provider Demographics
NPI:1497454532
Name:BALANCED LIFE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:BALANCED LIFE PSYCHOTHERAPY
Other - Org Name:BRITTANY HERNANDEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERANDNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-286-0897
Mailing Address - Street 1:1100 S MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2953
Mailing Address - Country:US
Mailing Address - Phone:575-286-0897
Mailing Address - Fax:
Practice Address - Street 1:1100 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2953
Practice Address - Country:US
Practice Address - Phone:575-286-0897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)