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General NPI Number Information
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NPI Number | 1275072621
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Entity Type | Organization
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Legal Business Name | BALANCED LIFE THERAPY GROUP, LLC
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 2875 NE 191ST ST SUITE 700
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City | AVENTURA
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State | FL
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Zip | 33180-2801
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Country | US
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Telephone | 786-227-3242
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 NE 191ST ST SUITE 700
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City | AVENTURA
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State | FL
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Zip | 33180-2801
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Country | US
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Telephone | 786-227-3242
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. MARIA SCOTTO
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Credential | LMHC
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Telephone | 786-227-3242
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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 | MH11701
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License Number State | FL
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