Provider Demographics
NPI:1316763485
Name:BALANCE AND BEYOND LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPOR
Entity type:Organization
Organization Name:BALANCE AND BEYOND LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:661-803-8011
Mailing Address - Street 1:28105 BOBWHITE CIR UNIT 117
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-4405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3604 OCEAN RANCH BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2669
Practice Address - Country:US
Practice Address - Phone:661-803-8011
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
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty