| Live Life Balanced Healing, Llc | |
|
2546 Johnson St Ne Minneapolis MN 55418-3941 | |
| (612) 444-1655 | |
| Not Available |
| Full Name | Live Life Balanced Healing, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2546 Johnson St Ne, Minneapolis, Minnesota |
| Authorized Official Name and Position | Shireen Ghanatabadi (OWNER/THERAPIST) |
| Authorized Official Contact | 6124441655 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Life Balanced Healing, Llc 2546 Johnson St Ne Minneapolis MN 55418-3941 Ph: () - | Live Life Balanced Healing, Llc 2546 Johnson St Ne Minneapolis MN 55418-3941 Ph: (612) 444-1655 |
| NPI Number | 1184402505 |
|---|---|
| Provider Enumeration Date | 09/18/2023 |
| Last Update Date | 09/18/2023 |
| Certification Date | 09/12/2023 |
| Medicare PECOS PAC ID | 3375983497 |
|---|---|
| Medicare Enrollment ID | O20240506003254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184402505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shireen J Ghanatabadi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952809899 PECOS PAC ID: 3173963295 Enrollment ID: I20240506003652 |
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