Provider Demographics
NPI:1376377846
Name:PURE BALANCE THERAPY
Entity type:Organization
Organization Name:PURE BALANCE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMONTREE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-449-2098
Mailing Address - Street 1:16905 BLACK WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9655
Mailing Address - Country:US
Mailing Address - Phone:517-449-2098
Mailing Address - Fax:
Practice Address - Street 1:4660 MARSH RD STE 20
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2143
Practice Address - Country:US
Practice Address - Phone:517-793-4913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty