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General NPI Number Information
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NPI Number | 1467601674
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Entity Type | Organization
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Legal Business Name | HEALTH BALANCE INTERNATIONAL
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 1627 FOOTHILL DR SUITE 10
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-2739
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Country | US
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Telephone | 801-688-2628
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Fax |
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Provider Business Mailing Address
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Address Line | 1627 FOOTHILL DR SUITE 10
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-2739
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Country | US
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Telephone | 801-688-2628
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Fax | 801-906-0735
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CHARLES MCCUSKER
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Credential |
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Telephone | 801-688-2628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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