Provider Demographics
NPI:1710414271
Name:BALANCED LIFE COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:BALANCED LIFE COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAHNAHSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-800-0311
Mailing Address - Street 1:PO BOX 50053
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-0053
Mailing Address - Country:US
Mailing Address - Phone:314-800-0311
Mailing Address - Fax:314-228-0367
Practice Address - Street 1:8045 BIG BEND BLVD STE 101/109
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2714
Practice Address - Country:US
Practice Address - Phone:314-800-0311
Practice Address - Fax:314-228-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011350180261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)