Basic Information
| Provider Information | |||||||||
| NPI: | 1619219524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BALANCE CENTER FOR CHILDREN AND FAMILIES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7440 SW HUNZIKER ROAD | ||||||||
| Address2: | SUITE: F | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035962222 | ||||||||
| FaxNumber: | 5032330187 | ||||||||
| Practice Location | |||||||||
| Address1: | 7440 SW HUNZIKER ROAD | ||||||||
| Address2: | SUITE: F | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035962222 | ||||||||
| FaxNumber: | 5032330187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 03/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | CABEZAS | ||||||||
| AuthorizedOfficialFirstName: | AZANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5035962222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L5639 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.