Provider Demographics
NPI:1013343474
Name:IDEAL BALANCE PLLC
Entity type:Organization
Organization Name:IDEAL BALANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-212-5674
Mailing Address - Street 1:8514 W GAGE BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8108
Mailing Address - Country:US
Mailing Address - Phone:509-524-9903
Mailing Address - Fax:
Practice Address - Street 1:8514 W GAGE BLVD STE G
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8108
Practice Address - Country:US
Practice Address - Phone:509-524-9903
Practice Address - Fax:888-745-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X, 251S00000X, 261QR0405X
WA03161300251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61492395OtherDOH LICENSE
WA61494502OtherDOH BRANCH LICENSE
WA2035070Medicaid