Provider Demographics
NPI:1528236817
Name:BALANCE PSYCHOLOGICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:BALANCE PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICESNED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENCHACA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-898-0926
Mailing Address - Street 1:1711 MILLENIUM WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1511
Mailing Address - Country:US
Mailing Address - Phone:208-898-0926
Mailing Address - Fax:208-884-0460
Practice Address - Street 1:1711 MILLENIUM WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1511
Practice Address - Country:US
Practice Address - Phone:208-898-0926
Practice Address - Fax:208-884-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty