Provider Demographics
NPI:1225853377
Name:IMPERFECTLY BALANCED COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:IMPERFECTLY BALANCED COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMHC
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:COWART
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-206-7372
Mailing Address - Street 1:2800 N 6TH ST # 5089
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1920
Mailing Address - Country:US
Mailing Address - Phone:904-206-7372
Mailing Address - Fax:
Practice Address - Street 1:35201 RADIO RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3148
Practice Address - Country:US
Practice Address - Phone:904-206-7372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty