| Balanced Life Counseling Llc | |
|
45 Fair St Wallingford CT 06492-4208 | |
| (860) 901-7916 | |
| Not Available |
| Full Name | Balanced Life Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 45 Fair St, Wallingford, Connecticut |
| Authorized Official Name and Position | Samantha Nicole Forst (SOCIAL WORKER) |
| Authorized Official Contact | 8609017916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Balanced Life Counseling Llc 2079 Killingly Cmns # 1019 Killingly CT 06241-2190 Ph: (860) 901-7916 | Balanced Life Counseling Llc 45 Fair St Wallingford CT 06492-4208 Ph: (860) 901-7916 |
| NPI Number | 1619634177 |
|---|---|
| Provider Enumeration Date | 11/19/2021 |
| Last Update Date | 07/03/2023 |
| Certification Date | 07/03/2023 |
| Medicare PECOS PAC ID | 0547623464 |
|---|---|
| Medicare Enrollment ID | O20230825000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619634177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Samantha Forst |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073193116 PECOS PAC ID: 0143638411 Enrollment ID: I20210427000430 |
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