MEDICARE: GRACEFULLY BALANCED PERINATAL COUNSELING LLC

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	374J00000X	Doula

General Provider Information

NPI Number	:	1174206080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFULLY BALANCED PERINATAL COUNSELING LLC

Provider Business Mailing Address
First Line	:	129 GARDEN RIDGE RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-2217
Country	:	US
Telephone Number	:	443-465-0317
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 GARDEN RIDGE RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-2217
Country	:	US
Telephone Number	:	443-465-0317
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JENIFER LANORE
Credential	:	LCSW-C
Telephone Number	:	443-465-0317

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/08/2023

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