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Contact Information

THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE
1107 B OPENWOOD ST.
VICKSBURG, MS39183
 Phone: 601-831-4402
 Fax: 601-262-7226
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
Indicates primary specialty

NPI Profile & details for THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE

NPI # 1649566894
LBN Legal business name THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE
Authorized official ANNETTE BRYANT - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 06/27/2011
Last updated 06/27/2011 - About 15 years ago
Identifiers
MS License # C6582
MS Medicaid 08000025
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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