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General NPI Number Information
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NPI Number | 1861002198
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Entity Type | Organization
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Legal Business Name | BALANCE OF LIFE, LLC
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Dates
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Enumeration Date | 08/02/2020
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Last Update Date | 08/02/2020
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Provider Practice Location Address
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Address Line | 15 LAKESIDE DR STE D
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1378
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Country | US
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Telephone | 314-660-3591
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 LIBERTY GARDENS CT
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City | FLORISSANT
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State | MO
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Zip | 63031-1948
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Country | US
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Telephone | 131-466-0359
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | ELIZABETH ANN ALLEN
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Credential | LCSW
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Telephone | 131-466-0359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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