Provider Demographics
NPI:1962223404
Name:BACK IN BALANCE COUNSELING & WELLNESS
Entity type:Organization
Organization Name:BACK IN BALANCE COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-903-9510
Mailing Address - Street 1:3813 LAS COLINAS AVE NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4394
Mailing Address - Country:US
Mailing Address - Phone:505-903-9510
Mailing Address - Fax:
Practice Address - Street 1:3813 LAS COLINAS AVE NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4394
Practice Address - Country:US
Practice Address - Phone:505-903-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty