| The Life Balance Clinic, Behavioral Health Service | |
|
1107 B Openwood St. Vicksburg MS 39183 | |
| (601) 831-4402 | |
| (601) 262-7226 |
| Full Name | The Life Balance Clinic, Behavioral Health Service |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1107 B Openwood St., Vicksburg, Mississippi |
| Authorized Official Name and Position | Annette Bryant (OWNER) |
| Authorized Official Contact | 6018314402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Life Balance Clinic, Behavioral Health Service 113 Woodstone Dr Vicksburg MS 39183-8319 Ph: (601) 831-4402 | The Life Balance Clinic, Behavioral Health Service 1107 B Openwood St. Vicksburg MS 39183 Ph: (601) 831-4402 |
| NPI Number | 1649566894 |
|---|---|
| Provider Enumeration Date | 06/27/2011 |
| Last Update Date | 06/27/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649566894 | NPI | - | NPPES |
| 08000025 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C6582 (Mississippi) | Primary |
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