Provider Demographics
NPI:1427499003
Name:NEW BALANCE PROFESSIONAL COUNSELING
Entity type:Organization
Organization Name:NEW BALANCE PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:JOLENE
Authorized Official - Last Name:BELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-421-6635
Mailing Address - Street 1:121 S WILCOX ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1910
Mailing Address - Country:US
Mailing Address - Phone:307-421-6635
Mailing Address - Fax:720-600-6792
Practice Address - Street 1:121 S WILCOX ST
Practice Address - Street 2:SUITE E
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1910
Practice Address - Country:US
Practice Address - Phone:307-421-6635
Practice Address - Fax:720-600-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011530251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health