Healthcare Provider Details

I. General information

NPI: 1881181568
Provider Name (Legal Business Name): ELIZABETH SUZANNE BALSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD UNIT 209
JACKSONVILLE FL
32258-5233
US

IV. Provider business mailing address

6753 STATE RD
PARMA OH
44134-4517
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5437
  • Fax: 904-503-3545
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: