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General NPI Number Information
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NPI Number | 1821709403
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Entity Type | Organization
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Legal Business Name | ENDEAVOR BALANCE, LLC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 2650 DADE AVE APT 1404
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City | ORLANDO
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State | FL
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Zip | 32804-4657
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Country | US
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Telephone | 407-497-5207
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Fax |
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Provider Business Mailing Address
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Address Line | 51 E JEFFERSON ST # 1326
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City | ORLANDO
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State | FL
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Zip | 32801-1832
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Country | US
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Telephone | 407-497-5207
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MS. SHENISE BAKER
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Credential | LMHC
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Telephone | 407-497-5207
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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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