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General NPI Number Information
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NPI Number | 1104725464
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Entity Type | Organization
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Legal Business Name | BALANCE LIFE THERAPY LLC
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 74 POLO RD
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City | COLUMBIA
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State | SC
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Zip | 29223-2806
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Country | US
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Telephone | 803-865-9655
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Fax |
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Provider Business Mailing Address
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Address Line | 250 MERRIMONT DR
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-6802
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | LARISSA TRAPP
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Credential | LMFT
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Telephone | 803-447-8171
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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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