Healthcare Provider Details

I. General information

NPI: 1629631817
Provider Name (Legal Business Name): LIFE BALANCE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 FILER AVE E # C
TWIN FALLS ID
83301-4118
US

IV. Provider business mailing address

1225 LANGFORD WAY
TWIN FALLS ID
83301-4785
US

V. Phone/Fax

Practice location:
  • Phone: 208-421-1788
  • Fax: 208-734-0211
Mailing address:
  • Phone: 208-421-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTINA SALAZAR TAPIA
Title or Position: LCSW
Credential: LCSW
Phone: 208-421-1788