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General NPI Number Information
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NPI Number | 1710414271
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Entity Type | Organization
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Legal Business Name | BALANCED LIFE COUNSELING & CONSULTING
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 8045 BIG BEND BLVD STE 101/109
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City | SAINT LOUIS
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State | MO
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Zip | 63119-2714
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Country | US
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Telephone | 314-800-0311
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Fax | 314-228-0367
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Provider Business Mailing Address
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Address Line | PO BOX 50053
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City | ALBUQUERQUE
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State | NM
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Zip | 87181-0053
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Country | US
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Telephone | 314-800-0311
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Fax | 314-228-0367
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | NAHNAHSHA DEAS
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Credential | LCSW
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Telephone | 314-800-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2011350180
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License Number State | MO
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