1427440239 NPI number — LIFEBALANCE COUNSELING COACHING AND WELLNESS PLLC

Table of content: (NPI 1427440239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427440239 NPI number — LIFEBALANCE COUNSELING COACHING AND WELLNESS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEBALANCE COUNSELING COACHING AND WELLNESS PLLC
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:
JESSICA M PINKHAM
Provider Other Organization Name Type Code:
5
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:
1427440239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 GONIC RD STE 2A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03839-5689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-332-8000
Provider Business Mailing Address Fax Number:
603-601-4476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 GONIC RD STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03839-5689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-332-8000
Provider Business Practice Location Address Fax Number:
603-601-4476
Provider Enumeration Date:
03/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PINKHAM
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
603-332-8000

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3101188 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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