Provider Demographics
NPI:1851141022
Name:ADVANCE BALANCE ALLIANCE LLC
Entity Type:Organization
Organization Name:ADVANCE BALANCE ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YILIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONTES DE OCA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-607-1008
Mailing Address - Street 1:1729 NW SAINT LUCIE WEST BLVD # 1275
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2501
Mailing Address - Country:US
Mailing Address - Phone:772-607-1008
Mailing Address - Fax:
Practice Address - Street 1:6044 NW WOLVERINE ROAD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:772-607-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health