Healthcare Provider Details

I. General information

NPI: 1104627660
Provider Name (Legal Business Name): BALANCED HEALTH CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CHURCH ST STE C
LAGRANGE GA
30240-2700
US

IV. Provider business mailing address

307 CHURCH ST STE C
LAGRANGE GA
30240-2700
US

V. Phone/Fax

Practice location:
  • Phone: 706-489-9095
  • Fax:
Mailing address:
  • Phone: 706-489-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JORDAN L CHILD
Title or Position: OWNER
Credential: LMFT
Phone: 706-523-0563