Provider Demographics
NPI:1568972107
Name:BALANCING LIFE CYCLES, LLC
Entity Type:Organization
Organization Name:BALANCING LIFE CYCLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-591-1514
Mailing Address - Street 1:500 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2808
Mailing Address - Country:US
Mailing Address - Phone:573-591-1514
Mailing Address - Fax:573-642-0087
Practice Address - Street 1:500 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2808
Practice Address - Country:US
Practice Address - Phone:573-591-1514
Practice Address - Fax:573-642-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130321851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty