Healthcare Provider Details

I. General information

NPI: 1760309173
Provider Name (Legal Business Name): BALANCE AND BLOOM THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1137 SUTLIFF RD NE
LISBON IA
52253-9200
US

IV. Provider business mailing address

1137 SUTLIFF RD NE
LISBON IA
52253-9200
US

V. Phone/Fax

Practice location:
  • Phone: 563-422-8195
  • Fax:
Mailing address:
  • Phone: 563-422-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA A LUCK
Title or Position: THERAPIST
Credential: LISW, CADC
Phone: 563-422-8195