Provider Demographics
NPI:1831367275
Name:LIFE IN BALANCE, A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:LIFE IN BALANCE, A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:G
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:650-847-0185
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-1036
Mailing Address - Country:US
Mailing Address - Phone:650-847-0185
Mailing Address - Fax:
Practice Address - Street 1:1720 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 220-C
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2702
Practice Address - Country:US
Practice Address - Phone:650-847-0185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26253103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty