Provider Demographics
NPI:1619219524
Name:BALANCE CENTER FOR CHILDREN AND FAMILIES, LLC
Entity Type:Organization
Organization Name:BALANCE CENTER FOR CHILDREN AND FAMILIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CABEZAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-596-2222
Mailing Address - Street 1:7440 SW HUNZIKER ROAD
Mailing Address - Street 2:SUITE: F
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-596-2222
Mailing Address - Fax:503-233-0187
Practice Address - Street 1:7440 SW HUNZIKER ROAD
Practice Address - Street 2:SUITE: F
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-596-2222
Practice Address - Fax:503-233-0187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL56391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty