Provider Demographics
NPI:1215481932
Name:BALANCED THERAPY
Entity type:Organization
Organization Name:BALANCED THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIZET
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:915-253-0622
Mailing Address - Street 1:12264 ROBERTA LYNNE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6809
Mailing Address - Country:US
Mailing Address - Phone:915-253-0622
Mailing Address - Fax:
Practice Address - Street 1:10600 MONTWOOD DR STE 116
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-2714
Practice Address - Country:US
Practice Address - Phone:915-253-0622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty