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General NPI Number Information
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NPI Number | 1972369031
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Entity Type | Organization
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Legal Business Name | BALANCE, A LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 849 S BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90014-3206
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Country | US
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Telephone | 949-237-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 1968 S COAST HWY STE 4025
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ANNA WELCH
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Credential |
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Telephone | 949-237-2272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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