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General NPI Number Information
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NPI Number | 1225332273
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Entity Type | Organization
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Legal Business Name | BALANCED
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 607 W BURTON AVE
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City | EUREKA
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State | IL
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Zip | 61530-1356
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Country | US
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Telephone | 309-251-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 607 W BURTON AVE
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City | EUREKA
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State | IL
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Zip | 61530-1356
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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 | LICENSED CLINICAL SOCIAL WORKER
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Name | AMY BRAMAN
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Credential |
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Telephone | 309-251-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149008793
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149011988
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License Number State | IL
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