Provider Demographics
NPI:1760137061
Name:BALANCE TO WELLNESS COUNSELING LLC
Entity Type:Organization
Organization Name:BALANCE TO WELLNESS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KEASLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-872-4798
Mailing Address - Street 1:1600 W MAUD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4726
Mailing Address - Country:US
Mailing Address - Phone:417-860-3458
Mailing Address - Fax:
Practice Address - Street 1:1600 W MAUD ST STE 2
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4726
Practice Address - Country:US
Practice Address - Phone:417-860-3458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty