MEDICARE: BALANCE THERAPY 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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1952044612	OTHER	TX	LPC

General Provider Information

NPI Number	:	1568243624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE THERAPY LLC

Provider Business Mailing Address
First Line	:	16914 SILVERWOOD DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2321
Country	:	US
Telephone Number	:	210-793-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	16914 SILVERWOOD DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2321
Country	:	US
Telephone Number	:	210-793-3311
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MYRIAM LILIANA LILIANA BERMUDEZ
Credential	:	LPC
Telephone Number	:	210-793-3311

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	10/16/2023

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Directions to “BALANCE THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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