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General NPI Number Information
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NPI Number | 1033625462
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Entity Type | Organization
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Legal Business Name | LIFE BALANCE INSTITUTE OF HEALING
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 1390 BROADWAY STE B297
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City | PLACERVILLE
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State | CA
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Zip | 95667-5900
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Country | US
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Telephone | 925-519-3375
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Fax | 925-666-4741
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Provider Business Mailing Address
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Address Line | 1390 BROADWAY STE B297
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City | PLACERVILLE
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State | CA
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Zip | 95667-5900
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Country | US
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Telephone | 925-519-3375
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Fax | 925-666-4741
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Authorized Official
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Title or Position | MFT CLINICIAN
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Name | MRS. KELLEE ANNETTE MILES-MARANZ
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Credential | M.A. MFT
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Telephone | 925-519-3375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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