Healthcare Provider Details

I. General information

NPI: 1265522247
Provider Name (Legal Business Name): URBAN BALANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N MICHIGAN AVE
CHICAGO IL
60601-7401
US

IV. Provider business mailing address

180 N MICHIGAN AVENUE SUITE 905
CHICAGO IL
60601
US

V. Phone/Fax

Practice location:
  • Phone: 312-726-7170
  • Fax:
Mailing address:
  • Phone: 312-726-7170
  • Fax: 312-782-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JOYCE B MARTER
Title or Position: CO FOUNDER
Credential: MA LCPC
Phone: 312-726-7170