Provider Demographics
NPI:1689229700
Name:BALANCE LIFE COUNSELING PLLC
Entity Type:Organization
Organization Name:BALANCE LIFE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:810-373-2053
Mailing Address - Street 1:10201 BENNETT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8767
Mailing Address - Country:US
Mailing Address - Phone:810-333-6666
Mailing Address - Fax:
Practice Address - Street 1:110 TREALOUT DR STE 104
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3211
Practice Address - Country:US
Practice Address - Phone:810-373-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty