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General NPI Number Information
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NPI Number | 1467749663
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Entity Type | Organization
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Legal Business Name | TOTAL BALNCE CENTER
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 5 AUSTIN DR
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City | MARLBOROUGH
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State | CT
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Zip | 06447-0331
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Country | US
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Telephone | 860-368-8949
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331 5 AUSTIN DR UNIT 2
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City | MARLBOROUGH
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State | CT
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Zip | 06447-0331
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Country | US
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Telephone | 860-368-8949
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LYNN CROMWELL
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Credential | LMFT
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Telephone | 860-368-8949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 001328
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License Number State | CT
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