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General NPI Number Information
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NPI Number | 1982424008
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Entity Type | Organization
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Legal Business Name | FOCUSED AND BALANCE LIFE THERAPY PLLC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 10024 SKOKIE BLVD STE 243
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City | SKOKIE
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State | IL
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Zip | 60077-9945
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Country | US
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Telephone | 224-255-7581
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Fax |
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Provider Business Mailing Address
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Address Line | 2726 W JARLATH ST
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City | CHICAGO
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State | IL
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Zip | 60645-1318
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Country | US
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Telephone | 847-209-9435
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN MIRETZKY
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Credential |
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Telephone | 847-209-9435
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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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