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General NPI Number Information
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NPI Number | 1487376315
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Entity Type | Organization
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Legal Business Name | BALANCE TREATMENT SLO, INC.
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 2 LOWER RAGSDALE DRIVE, SUITE 120
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City | MONTEREY
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State | CA
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Zip | 93940
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Country | US
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Telephone | 855-414-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 LAS VIRGENES RD. STE. 201
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City | CALABASAS
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State | CA
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Zip | 91302
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Country | US
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Telephone | 323-646-9271
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JENNIFER CUSACK
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Credential |
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Telephone | 323-646-9271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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