Provider Demographics
NPI:1992013999
Name:BALANCED LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:BALANCED LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RYALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-962-5022
Mailing Address - Street 1:762 W MICHIGAN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1963
Mailing Address - Country:US
Mailing Address - Phone:517-962-5022
Mailing Address - Fax:517-962-5195
Practice Address - Street 1:762 W MICHIGAN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1963
Practice Address - Country:US
Practice Address - Phone:517-962-5022
Practice Address - Fax:517-962-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty