Healthcare Provider Details

I. General information

NPI: 1972369031
Provider Name (Legal Business Name): BALANCE, A LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 S BROADWAY
LOS ANGELES CA
90014-3206
US

IV. Provider business mailing address

1968 S COAST HWY STE 4025
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 949-237-2272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNA WELCH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 949-237-2272