Provider Demographics
NPI:1841756525
Name:BALANCE THERAPEUTIC CARE, COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:BALANCE THERAPEUTIC CARE, COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MARTICE
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-599-1034
Mailing Address - Street 1:661 A
Mailing Address - Street 2:31-W BYPASS
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101
Mailing Address - Country:US
Mailing Address - Phone:270-599-1034
Mailing Address - Fax:270-599-1035
Practice Address - Street 1:901 BEAUTY AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6135
Practice Address - Country:US
Practice Address - Phone:270-599-1034
Practice Address - Fax:270-599-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100418070Medicaid