| Life Balance Clinic Llc | |
|
1107 Openwood St Vicksburg MS 39183 | |
| (601) 831-4402 | |
| (601) 206-0672 |
| Full Name | Life Balance Clinic Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1107 Openwood St, Vicksburg, Mississippi |
| Authorized Official Name and Position | Annette Bryant (OWNER/PROVIDER) |
| Authorized Official Contact | 6018314402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Balance Clinic Llc 113 Woodstone Dr Vicksburg MS 39183-8319 Ph: (601) 831-4402 | Life Balance Clinic Llc 1107 Openwood St Vicksburg MS 39183 Ph: (601) 831-4402 |
| NPI Number | 1811244858 |
|---|---|
| Provider Enumeration Date | 08/09/2012 |
| Last Update Date | 08/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811244858 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C6582 (Mississippi) | Primary |
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