Provider Demographics
NPI:1215608476
Name:NEO-BALANCE MARRIAGE THERAPY AND RECOVERY, PC
Entity type:Organization
Organization Name:NEO-BALANCE MARRIAGE THERAPY AND RECOVERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-996-3065
Mailing Address - Street 1:PO BOX 1708
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91933-1708
Mailing Address - Country:US
Mailing Address - Phone:619-660-3065
Mailing Address - Fax:
Practice Address - Street 1:1414 4TH ST
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1906
Practice Address - Country:US
Practice Address - Phone:619-996-3065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)