Healthcare Provider Details

I. General information

NPI: 1770354896
Provider Name (Legal Business Name): BALANCED LIVING BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 E HYACINTH ST
NAMPA ID
83687-7811
US

IV. Provider business mailing address

8821 E HYACINTH ST
NAMPA ID
83687-7811
US

V. Phone/Fax

Practice location:
  • Phone: 208-284-3992
  • Fax:
Mailing address:
  • Phone: 208-284-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SARA H PALMER
Title or Position: CO-OWNER
Credential: PH.D.
Phone: 208-284-3992