Provider Demographics
NPI:1396589651
Name:BALANCED DYNAMICS COUNSELING PLLC
Entity type:Organization
Organization Name:BALANCED DYNAMICS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WOODBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:208-505-9229
Mailing Address - Street 1:1216 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9634
Mailing Address - Country:US
Mailing Address - Phone:208-629-9629
Mailing Address - Fax:
Practice Address - Street 1:9628 W STATE ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5858
Practice Address - Country:US
Practice Address - Phone:208-505-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty