Provider Demographics
NPI:1013297837
Name:A BALANCED LIFE: INDIVIDUAL, FAMILY & CHILD THERAPY, INC.
Entity Type:Organization
Organization Name:A BALANCED LIFE: INDIVIDUAL, FAMILY & CHILD THERAPY, INC.
Other - Org Name:A BALANCED LIFE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:I
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-544-1748
Mailing Address - Street 1:2100 ELOISE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-4306
Mailing Address - Country:US
Mailing Address - Phone:530-544-1748
Mailing Address - Fax:530-544-1728
Practice Address - Street 1:2100 ELOISE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-4306
Practice Address - Country:US
Practice Address - Phone:530-544-1748
Practice Address - Fax:530-544-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50196101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty