Healthcare Provider Details

I. General information

NPI: 1922997006
Provider Name (Legal Business Name): BALANCED HEART AND MIND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30941 AGOURA RD STE 116
WESTLAKE VILLAGE CA
91361-4636
US

IV. Provider business mailing address

30941 AGOURA RD STE 116
WESTLAKE VILLAGE CA
91361-4636
US

V. Phone/Fax

Practice location:
  • Phone: 805-243-8903
  • Fax:
Mailing address:
  • Phone: 805-876-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LIEZEL LAUGUICO
Title or Position: LMFT
Credential:
Phone: 805-243-8903