1083258370 NPI number — LIFE BALANCE COUNSELING, LLC

Table of content: GRACE ANNE GENSAMER MASSAGE THERAPIST (NPI 1225637663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083258370 NPI number — LIFE BALANCE COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE BALANCE COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083258370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6237 PRESIDENTIAL CT STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33919-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-312-5352
Provider Business Mailing Address Fax Number:
239-230-3029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6237 PRESIDENTIAL CT STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33919-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-312-5352
Provider Business Practice Location Address Fax Number:
239-230-3029
Provider Enumeration Date:
10/30/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
239-312-5352

Provider Taxonomy Codes

  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)