MEDICARE: LIFE BALANCE INSTITUTE OF HEALING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033625462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE BALANCE INSTITUTE OF HEALING

Provider Business Mailing Address
First Line	:	1390 BROADWAY STE B297
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-5900
Country	:	US
Telephone Number	:	925-519-3375
Fax Number	:	925-666-4741

Provider Business Practice Location Address
First Line	:	1390 BROADWAY STE B297
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-5900
Country	:	US
Telephone Number	:	925-519-3375
Fax Number	:	925-666-4741

Authorized Official
Title or Position	:	MFT CLINICIAN
Name	:	MRS. KELLEE ANNETTE MILES-MARANZ
Credential	:	M.A. MFT
Telephone Number	:	925-519-3375

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	02/16/2023

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Directions to “LIFE BALANCE INSTITUTE OF HEALING ” Practice Location

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