Healthcare Provider Details

I. General information

NPI: 1689586554
Provider Name (Legal Business Name): BALANCED PERSPECTIVE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 MYRTLE ST
WESTBROOK ME
04092-3511
US

IV. Provider business mailing address

PO BOX 96
GORHAM ME
04038-0096
US

V. Phone/Fax

Practice location:
  • Phone: 207-415-2591
  • Fax:
Mailing address:
  • Phone: 207-415-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KARI WAGNER
Title or Position: OWNER LCSW
Credential:
Phone: 207-415-2591