| A Balanced Life: Individual, Family & Child Therapy, Inc. | |
|
2100 Eloise Ave South Lake Tahoe CA 96150-4306 | |
| (530) 544-1748 | |
| (530) 544-1728 |
| Full Name | A Balanced Life: Individual, Family & Child Therapy, Inc. |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2100 Eloise Ave, South Lake Tahoe, California |
| Authorized Official Name and Position | Lindsay I Simon (DIRECTOR) |
| Authorized Official Contact | 5305441748 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Balanced Life: Individual, Family & Child Therapy, Inc. 2100 Eloise Ave South Lake Tahoe CA 96150-4306 Ph: (530) 544-1748 | A Balanced Life: Individual, Family & Child Therapy, Inc. 2100 Eloise Ave South Lake Tahoe CA 96150-4306 Ph: (530) 544-1748 |
| NPI Number | 1013297837 |
|---|---|
| Provider Enumeration Date | 08/24/2011 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 9234402058 |
|---|---|
| Medicare Enrollment ID | O20170830001048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013297837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 50196 (California) | Secondary |
| 106H00000X | Marriage & Family Therapist | 50196 (California) | Primary |
| Provider Name | Marianna Randolph |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609150853 PECOS PAC ID: 9032363767 Enrollment ID: I20130206000052 |
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