Provider Demographics
NPI:1972198711
Name:BALANCED LIFE COUPLE FAMILY AND INDIVIDUAL THERAPY CENTER INC.
Entity Type:Organization
Organization Name:BALANCED LIFE COUPLE FAMILY AND INDIVIDUAL THERAPY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LANCASTER
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-573-0682
Mailing Address - Street 1:127 E LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4511
Mailing Address - Country:US
Mailing Address - Phone:619-573-0682
Mailing Address - Fax:619-328-6591
Practice Address - Street 1:127 E LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4511
Practice Address - Country:US
Practice Address - Phone:619-573-0682
Practice Address - Fax:619-328-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty