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General NPI Number Information
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NPI Number | 1265740096
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Entity Type | Organization
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Legal Business Name | BALANCE FOR HEALTHY LIVING, PC
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 6129 NE SKIDMORE ST
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City | PORTLAND
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State | OR
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Zip | 97218-2227
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Country | US
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Telephone | 503-407-9232
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Fax |
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Provider Business Mailing Address
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Address Line | 6129 NE SKIDMORE ST
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City | PORTLAND
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State | OR
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Zip | 97218-2227
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Country | US
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Telephone | 503-407-9232
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | TIRZAH D JACOB
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Credential |
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Telephone | 503-407-9232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C1780
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C1780
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C1780
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License Number State | OR
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