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General NPI Number Information
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NPI Number | 1679172217
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Entity Type | Organization
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Legal Business Name | RESTORING BALANCE THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 10/24/2020
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 20 W MAIN STREET CT STE 200
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City | ALPINE
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State | UT
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Zip | 84004-1889
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Country | US
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Telephone | 801-857-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 20 W MAIN STREET CT STE 200
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City | ALPINE
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State | UT
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Zip | 84004-1889
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Country | US
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Telephone | 385-387-1099
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Fax | 385-387-1243
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Authorized Official
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Title or Position | CO-OWNER
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Name | CAIDY ATWOOD
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Credential | CMHC
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Telephone | 801-857-1101
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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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