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General NPI Number Information
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NPI Number | 1316763485
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Entity Type | Organization
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Legal Business Name | BALANCE AND BEYOND LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPOR
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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 | 3604 OCEAN RANCH BLVD
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City | OCEANSIDE
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State | CA
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Zip | 92056-2669
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Country | US
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Telephone | 661-803-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 28105 BOBWHITE CIR UNIT 117
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City | SAUGUS
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State | CA
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Zip | 91350-4405
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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 | CEO
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Name | ALEX WAYNE
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Credential | LCSW
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Telephone | 661-803-8011
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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 |
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License Number State |
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