Healthcare Provider Details

I. General information

NPI: 1073307724
Provider Name (Legal Business Name): BALANCEABILITY WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8457 PHLOX DR
BUENA PARK CA
90620-2126
US

IV. Provider business mailing address

8457 PHLOX DR
BUENA PARK CA
90620-2126
US

V. Phone/Fax

Practice location:
  • Phone: 949-351-4343
  • Fax:
Mailing address:
  • Phone: 949-351-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HARLIN BEWLI
Title or Position: FOUNDER & CEO
Credential:
Phone: 949-351-4343