Provider Demographics
NPI:1760861173
Name:BALANCED LIFESTYLES COUNSELING, LLC
Entity Type:Organization
Organization Name:BALANCED LIFESTYLES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RN
Authorized Official - Phone:801-390-3447
Mailing Address - Street 1:5521 WOODLAND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-5134
Mailing Address - Country:US
Mailing Address - Phone:801-390-3447
Mailing Address - Fax:
Practice Address - Street 1:5521 WOODLAND CIRCLE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-5134
Practice Address - Country:US
Practice Address - Phone:801-390-3447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13849935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000060365Medicare PIN