Provider Demographics
NPI:1659019438
Name:BALANCED WATERS FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:BALANCED WATERS FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:562-896-4694
Mailing Address - Street 1:4433 E VILLAGE RD STE H
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1505
Mailing Address - Country:US
Mailing Address - Phone:562-896-4694
Mailing Address - Fax:
Practice Address - Street 1:4433 E VILLAGE RD STE H
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1505
Practice Address - Country:US
Practice Address - Phone:562-896-4694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty