Healthcare Provider Details

I. General information

NPI: 1518628023
Provider Name (Legal Business Name): BALANCE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HUNTCLIFF STE 1230
ATLANTA GA
30350-1898
US

IV. Provider business mailing address

1010 HUNTCLIFF STE 1230
ATLANTA GA
30350-1898
US

V. Phone/Fax

Practice location:
  • Phone: 404-736-1410
  • Fax: 901-457-4568
Mailing address:
  • Phone: 404-736-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEX W PETERSON
Title or Position: OWNER
Credential: NP
Phone: 404-736-1410