MEDICARE: BALANCED LIFE PSYCHIATRIC CARE, PLLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1205779881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED LIFE PSYCHIATRIC CARE, PLLC

Provider Business Mailing Address
First Line	:	87 PUTNAM ST
Second Line	:
City	:	BRISTOL
State	:	CT
Zip	:	06010-4946
Country	:	US
Telephone Number	:	860-294-9749
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 PUTNAM ST
Second Line	:
City	:	BRISTOL
State	:	CT
Zip	:	06010-4946
Country	:	US
Telephone Number	:	860-891-6726
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EVETTE NATASHA JAMES
Credential	:	NURSE PRACITIONER
Telephone Number	:	860-294-9749

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/14/2026

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