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General NPI Number Information
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NPI Number | 1225853377
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Entity Type | Organization
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Legal Business Name | IMPERFECTLY BALANCED COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 35201 RADIO RD
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City | LEESBURG
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State | FL
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Zip | 34788-3148
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Country | US
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Telephone | 904-206-7372
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 N 6TH ST # 5089
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-1920
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Country | US
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Telephone | 904-206-7372
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Fax |
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Authorized Official
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Title or Position | OWNER/LMHC
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Name | MS. LAURA COWART
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Credential | LMHC
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Telephone | 904-206-7372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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