Healthcare Provider Details

I. General information

NPI: 1134099575
Provider Name (Legal Business Name): BALANCED MAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 KAVANAUGH BLVD STE 7
LITTLE ROCK AR
72205-3991
US

IV. Provider business mailing address

2601 KAVANAUGH BLVD STE 7
LITTLE ROCK AR
72205-3991
US

V. Phone/Fax

Practice location:
  • Phone: 501-680-6963
  • Fax:
Mailing address:
  • Phone: 501-680-6963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: CORA CRAIN
Title or Position: OWNER
Credential: MMT, CD(DONA)
Phone: 501-680-6963