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General NPI Number Information
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NPI Number | 1366071292
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Entity Type | Organization
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Legal Business Name | URBAN BALANCE THERAPY AND CONSULTING LLC
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 723 15TH AVENUE
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City | EAST MOLINE
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State | IL
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Zip | 61244-9998
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Country | US
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Telephone | 309-737-9263
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Fax |
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Provider Business Mailing Address
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Address Line | 723 15TH AVENUE
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City | EAST MOLINE
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State | IL
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Zip | 61244-9998
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Country | US
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Telephone | 309-737-9263
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Fax |
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Authorized Official
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Title or Position | OWNER/LCPC
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Name | MS. FARAH E ANDERSON
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Credential | LCPC
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Telephone | 309-737-9263
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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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