=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629302856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALANCE COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2009
-----------------------------------------------------
Last Update Date | 09/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 SCHOFIELD AVE BOX 10
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54476-2376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-355-1088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2215 SCHOFIELD AVE BOX 10
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54476-2376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-355-1088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | MS. LISA LYN BERRY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 715-355-1088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------